08-103030 -1 ''''-i,WCEIV5IP iikz _ \ osca 0
Federal 2 3 2008 PERMIT SF MF CO ME EL PL DE EI'
C0MWNI7Y DBVELDPMBNT SBRVI
33335 dm R L WAY, A77f. 971 A I C A T I GIST *�/
FEDERAL WAY,WA 98063-9718 y
1 253-835-2607*�- FAX 253-835-2609 v a
"+OF FEDERAL 6
1 The following is requiretCe cation-an incomplete application will not bi ii�ptej; Please print legibly(in ink)or type.
IN PROPERTY INFORMATION
SITE ADDRESS_ Z e)Q Z'-1 C7 L W SUITE/UNIT•_
ASSESSOR'S TAX/PARCEL# — - S — __ LOT SIZE(sj
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach•momic Page OrWOW legal denriPtioitl
E a PROJECT INFORMATION
TYPE OF PERMIT ❑BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
XPROJECT DESCRIPTION(Provide detailed description of work included on this permit onluj
'mss#c.tX i i t Sp,i Ai .1 Ptr s y s+e-v-t Z'Ai s F R- g 4,4 1-O DSc
f)7►i .A.)F,'4 17s -b /occ( 5f-e-t:craSc/$.
xPROJECT NAME(Name of Business or Owner Last Name) t ;a CCU ,U6 CJ Z e S .
• PEOPLE INFORMATION
PROPERTY NAME \ PRIMARY PHONE
OWNER ∎C.. rAAuOtJ ( ) -
MAILING ADDRESS CITY,ST FE,ZIP E-MAIL ADDRESS
SttO .20 'A 01, Sw > Mkt(4/AA uo/A-
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
tali a 1--4 Ai r'/e pi 0'ec z e- a (-Ie(♦av (4d2s)4//7 :.S'7 V 1
3 (�v CITY,STATE ZIP G�D CELL PHON
CITY OFFEDERAL WAY BUSINE33 LICENSE NUMBER /ER!'[RATZON 9TB 1 5 Y FAX NUMBER
` "
05r— 1 Off( CO oa ( 2, _ 1 , o,)' ( ) -
CONTRACTOR'S REGISTRATION ER 6.. EXPIRATION DATE i E-MAIL ADDRESS
_
5(j APPLICANT COMPANY NAME `.�► /"1�/t'� 4 G/bu APPLICANT NAME OFFICE PHONE _
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑Tenant ❑Agent ❑ Other ( ) -
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT ( ) -
LENDER ME er RC ' •.27.095:
Lender Info it is rsqu • project value exceeds$5,000
I .ADD•s' CITY,STATE,ZIP PHONE
• DETAILED BUILDING INFORMATION
EXISTING USE P
EXISTING ASSESSED/APPRAISED VALUE$ UE OF PROPOSED WORK $ ...570%/0. 0
00
SPRINKLERED BUILDING? ❑YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQ I -1• ' ❑ • :A: ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
- a
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
•
THIRD
ADDITIONAL FLOORS(DESCRIBE) !
•
DECK(0 COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
•
NUMBER OF FLOORS ammo PRO • I TOTAL TOTALS.=SING Mt TOTAL PROPOSED er TOTAL Sr
•
•
"NEW HOMES ONLY** NUMBER OF B 'OOMS ESTIMATED SELLING PRICE $ •
•
■ FIXTURES
Indicate number of each type of .+ -• to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work$ COPY OF BID OR ESTIMATE MUST BE INCL ED WITH APPLICATION)
AIR HANDLING UNITS EV ••RATIVE COOLERS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLA INSERTS HOODS Icommerd,q
COMPRESSORS FURNACES RANGES
DUCTS • OAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower combo) LAV'(Bathroom URINALS MISC(Describe)
• DISHWASHERS r I NWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(ram •
ELECTRIC WATER HEATERS SINKS ASHING MACHINES
HOSE BIBBS SUMPS
•
SIGNATURE •
I certify under penalty of perjury that I am the property owner or authorised 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 Wag 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 undersi a and filed
where such claim arts t of the reliance of the city, including its officers and employees, on the accuracy of the the city, but only
up cdl j information supplied to
the city as a part • •plication.
-�[ SIGNATURE: DATE
l\ WY, Property Owner and/or Authorized Agent
•
a NEW a ADDITION . a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a,YES a NO
•ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO
•
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Petmit Application