08-100991CITY of _. "— ,� D – =(, L
Federal Why
COMMUNITY DEVELOPb1ENT SERVICE
E 2 6 2008 PERMIT SF MF CO ME EL PL DE EN
33325 ST"AVENUE SOUTH • PO BOX 97 APT ,I CATION
FEDERAL WAY, WA 98063 -9718
253-835-2607- u,ww. FAX 253 -835-2600 FED E
www.cit o ede
The following is required ioaDGtion - an incomplete application will not be accepted. Please print legibly (in ink) or type.
p PROPERTY INFORMATION
SITE ADDRESS 6 Z / -3SG ��! J f SUITE /UNIT #
ASSESSOR'S TAX /PARCEL # Z 9 2 / O _3�_ - O L _ LOT SIZE (s,)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page far lengthy legal descriptioN
PROJECT • •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING X FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
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PROJECT NAME (Name of Business or Owner Last Namel 19? 1
PROPERTY
OWNER
CONTRACTOR
(0)p
APPLICANT
PROJECT
CONTACT
LENDER
NAME
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G'or�.ali�..vis ► G�r urn
PRIMARY PHONE
( ) -
MAILING ADDRESS
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CITY, STATE, ZIP
,mv ,
E -MAIL ADDRESS
COMPANY NAME
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APPLICANT' NAME
&O000t
OFFICE PHONE
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MAILIN DRESS
CITY, STATE, ZIP
CELL PHONE
FAX NUMBER
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(2J ) 6 /
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CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
IRATION DATE
FAX NUMBER
(ZS )
-
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771y
CONTRACTOR'S REGISTRATION NUMBER
EXPIRATION DATE
E -MAIL ADDRESS
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le one
COMPANY NAME
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APPLICANT NAME
OFFICE PHONE
( ) -
MAILING ADD
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other
( ) -
NAME lee, PRIMARY PHONE E -MAIL ADDRESS
NAME
Per RCW 19.27.095:
Lender information is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING USE Ch N/'ZC',tiG g 7'l"
EXISTING ASSESSED /APPRAISED VALUE $
PROPOSED USE
S cynic
VALUE OF PROPOSED WORK $ -7
SPRINKLERED BUILDING? X YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
0
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
FIRST
O'
COMPRESSORS
711,00
RANGES
SECOND
GAS LOG SETS
REFRIG. SYSTEMS
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED ?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
IS
ERTMO
PROPOSED
TOTAL
TOTAL MUSTTNG SP
TOTA L PROPOSED SF
TOTAL SF
" *NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
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 (co —rdap
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
PLUMBING
BATHTUBS (or MLb /shown Combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
LAVS (Bathroom sinks)
URINALS MISC (Describe)
RAINWATER SYST
VACUUM BREAKERS
SHOWERS
WATER CLOSETS (T iia)
SINKS
WASHING MACHINES
SUMPS
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 authorized 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 apart of this application. J*� p
SIGNATURE: . _ f DATE Ti �ZL " 40
Property Owner and /or Authorized Agent
FOROFFICE USWONL3E..
D NEW D ADDITION D ALTERATION D REPAIR D TENANT IMPROVEMENT
BUILDING SHELL ONLY? D YES ❑ NO BASIC PLAN? D YES ❑ NO
ZONING DESIGNATION CHANGE OF USE? D YES D NO
NEW ADDRESS REQUIRED? D YES D NO UP /SEPA /SU? D YES D NO
PLATTED LOT? D YES D NO DEMO PERMIT REQUIRED? D YES D NO
Bulletin #100 -January 1, 2008 Page 2 of 4 k\Handouts\Pennit Application