08-100230J
Federal way �?ERMIT
e
COMMUNITYDEVELOPMENT SERVICES -SF CO ME EL PL DE EN P
333251"A VENUE SOUTH • PO BOX 9718 N
FEDERAL WAY, WA 98063.9718
.253.835 -2607• FAX 253 - 835.2609 APPLICATION
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The following is required information — an inc mP1e IV
o� ` �tTo�l ►t 1,.IIat be acceptl 4. Please print legibly (in ink) or type.
-PROPERTY •. •
SITE ADDRESS �.?�` —�' ���{� `� SUITE /UNIT #
ASSESSOR'S TAX /PARCEL # LOT: SIZE (sf)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) �T
]Attach separate page far kngthy legal desgiptlonl
TYPE OF -PERMIT ❑ BUILDING O PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this Permit onlu)
PROJECT NAME (Name of Business or Owner Last Name) __)`
PROPERTY
OWNER
CONTRACTOR
f�
COPY of card reqL..
APPLICANT
PROJECT
CONTACT
LENDER
. COMPANY NAME
PerRCW 19.27.095:
Lender irtformation is required i f project value exceeds $5,000
-
APP,LICANT NAME
PHONE
OF ICE PHONE
L!N DD
S
A E, ZIP
CITY OF FEDERAL WAY BUSINESS
LICENSE NUMB
PI
DATE
UMBER
.TON
CONILM L,79R'S
GIST
Tl N NUMBER
EXPIRATION
15ATE
E -MAIL ADDRESS
❑ Architect ❑ Tenant ❑ Agent ❑ Other
)(,::AA
NAME 1 PRIMARY PHONE E MAIL ADDRESS
NAME
PerRCW 19.27.095:
Lender irtformation is required i f project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING USE PROPOSED USE OF V-\C G.
EXISTING ASSESSED /APPRAISED VALUE $ _ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ' 6ES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? IYES ONO
WATER SERVICE PROVIDER `f(,LAKEHAVEN 0 HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER E.LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
l
t
4
AREA DESCRIPTION
EXISTING
SQ. FT:
OPOSED
FT.
TOTAL
S . FT.
BASEMENT
FANS
GAS WATER HEATERS
MISC (Describe) i
FIRST
FIREPLACE INSERTS
0
1
'ECOND
FURNACES
RANGES
ZONING DESIGNATION
THIRD
GAS LOG SETS
REFRIG. SYSTEMS
o YES
ADDITIONAL FLOORS (DESCRIBE)
NEW ADDRESS REQUIRED?
o YES o NO
i
DECK (O COVERED OR D_UNCOVERED ?)
LAYS (Bath— sird.)
URINALS
MISC (Describe; i
GARAGE 0 CARPORT C7
RAINWATER SYST
VACUUM BREAKERS
o YES
NUMBER OF FLOORS
EXI8TIR6
PROPOSED
TOTAL
TOTAL EJISTDiO sr
TOTAL PROPOSED Sr
TOT.ti.
—NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of f.UCture to be installed or relocated as. part of this project. Da not include existing fvdures to remain.
MECHAHICAL
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) i
BOILERS
FIREPLACE INSERTS
HOODS (c —er64
1
COMPRESSORS
FURNACES
RANGES
ZONING DESIGNATION
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
o YES
G
NEW ADDRESS REQUIRED?
o YES o NO
i
BATHTUBS (arTub/sh —rC-k
LAYS (Bath— sird.)
URINALS
MISC (Describe; i
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
o YES
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS rroneq
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HnsF. BIBBS
SUMPS
I certify under.penalty of perjury that the information furnished by me is true: and correct to the best of my knowledge, and further, that I
am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 flied against the City of Federal Way, 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
this application. X11
NAME /TITLE
SATE I -IS'O �
RELATIONSHIP TO/fROJECT
O Owner D Agent
Contractor C Architect o Other
o NEW o ADDITION
o ALTERATION
o REPAIR ❑.TENANT IMPROVEMENT.
BUILDING SHELL. ONLY?
o YES ❑ NO
BASIC PLAN?
o YES
o NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
o NO
NEW ADDRESS REQUIRED?
o YES o NO
UP /SEPA /SUP
o YES
o NO
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED?
o YES
ONO
40
Bulietin #10()- 3anuaryi.200i Page2 -of 4 k\} andouts \Permit Application .