09-101530V.
CITY OF &AECEI'A ic.� _Z Y —f� Fed E RM ITs``�`°
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE EN
33325 D RALWA SOUTH• 63971 9718gpR 2 4 2XPPLICATION TD
FEDERAL WAY, WA 98063 -97]8
253- 835 -2607• FAX 253- 835 -2609
www.tituo ederat CF FEDERAL WAY
The following is required irQSton -an incomplete application will not be accepted. Please print legibly (in ink) or type.
11 PROPERTY •• •
SITE ADDRESS -301L) '50. .V y lv l 51• SUITE /UNIT #
ASSESSOR'S TAX /PARCEL # 2 2 _L O 4- - ! v; "_ LOT SIZE (sf)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
/Attach sepamrte page for lengthy legal descn�lon)
1 PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
/FIRE PREVENTION SYSTEM
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu) tb
Sm 4, F re Sus�em1 s I IBC C5 ) tai I t mod i-�i �e�yex -i ski r�q SPr I nkle- SUs�
e%_'n__AkAAlm -NAP nPa1l YV10- "AnVlin -e n ,A J1aIrS' _
PROJECT NAME (Name of Business or Owner Last Name)
PEOPLE •• •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
NAME PRIMARY PHONE
MAILING AD ES CITY, STATE, ZIP �� 03 I E -MAIL ADDRESS
S631 S. Tl
COMPANY NAME
Srn i-Wi Fi ne S S�rYI S l n L
�AFPLICANT NAME
Ve+rUni C l a i n a�D �a
OFFICE PHONE
(Z�3) 2 �{ - ��6
MAILING ADDRESS
I19LO Ave JE
CITY, STATE, ZIP
T�CDm'� WH
CELL PHONE
-
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
f 1 T7 0000 5S 6�-
EXPIRATION DATE
/2/3l lo9
FAX NUMBER
(2e3)L?2� - 2350
CONTRACTOR'S REGISTRATION NUMBER
EXPIRATION DATE
/2 /31 f Dq
E -MAIL ADDRESS
Vfainq� DEDsmw* r
S M IT 9 FS /36 0T
PANY "i r Inc.
COM e S stems
APPLICANT NAME
11 ai/ 4 fe7 4o
OFFICE PHONE
(253)2-,/8 - 26(.,o'
1 /01AD411vT;eoma
IP
tc) y
CELL PHONE -
RELATIONSHIP TO PROJECT
'E rrl / e `
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent 12r/
ADDRESS
Gil
NAME Per RCW 19.27.095:
Lender information is required if project value exceeds $5,000
EXISTING USE &&Sir - SS PROPOSED USE
VALUE OF PROPOSED WORK
EXISTING ASSESSED /APPRAISED //VALUE $$_
SPRINKLERED BUILDING? [AYES ❑ NO
FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? WYES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
ME
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SO. FT.
TOTAL
S . FT.
BASEMENT
WATER CLOSETS (Toilet)
SINKS
WASHING MACHINES
FIRST
UP /SEPA /SU?
❑ YES
❑ NO
SECOND
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED ?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
67QSTISO
PROPOSED
TOTAL
TOTAL 1"77" Sr
TOTAL PROPOSM sr
TOTAL Sr
* *NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work .$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC (Describe)
BOILERS FIREPLACE INSERTS HOODS (commerciaq
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG. SYSTEMS
PLUMBING
BATHTUBS (or Tub /Shower combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
LAVS (Bathroom Sinks)
URINALS MISC (Describe)
RAINWATER SYST
VACUUM BREAKERS
SHOWERS
WATER CLOSETS (Toilet)
SINKS
WASHING MACHINES
SUMPS
UP /SEPA /SU?
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the best of my
knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with all applicable
City of Federal Way regulations pertaining to the work authorised by the issuance of a permit. I understand that the issuance of this permit
does not remove the owner's responsibility for compliance with local, state, or federal laws regulating construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in the
investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the city, but only
where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the information supplied to
the city as a part of 1117ts application.
SIGNATURE: ` F—'
❑ NEW ❑ ADDITION
BUILDING SHELL ONLY?
ZONING DESIGNATION
❑ ALTERATION
❑ YES ❑ NO
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT?
❑ YES o NO
ay a3 Io q
or Authorized
❑ REPAIR ❑ TENANT IMPROVEMENT
Bulletin #100 — January 1, 2009 Page 2 of 4 k\Handouts\Permit Application
BASIC PLAN?
❑ YES
o NO
CHANGE OF USE?
❑ YES
❑ NO
UP /SEPA /SU?
❑ YES
❑ NO
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
Bulletin #100 — January 1, 2009 Page 2 of 4 k\Handouts\Permit Application