09-100511 . _ \ o0 51I.
I RE 'DRMIT
COMMENT DEVELOPMENTSBRWCB3 SF MF CO ME EL PL DE EN
33315DERALYUY,WA SOUTH•P -BOX 9718 9718 FEB 0AFF9PLICATION
FEDERAL WAY,WA 98063-97]8 .__ / /
253-835-2607.FAX 253-835-2609
1910P.dtuu/Redemdoau.oj'
The following 1s l l&
ogi&Et4 En hte application will not be accepted. Please print legibly(In ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS • • f + z,V . 6 a . U i g Fires i t -'1 k
2 4 .
ASSESSOR'S TAX/PARCEL# ?! 2�� - 0 nW�t4d ved LOT SIZE(fl
®Subject to attached details
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(A Pagalat W‘
I. PROJECT INFORMATION
- - — — e
TYPE OF PERMIT ❑BUILDING 0 PLUMBING 0 MECHANICAL
❑ DEMOLITION 0 ELECTRICAL ❑ ENGINEERING A FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this Hermit onlu)
P6c1,. C 4—rc-We_ sV,Y W\k r \r eear S
PROJECT NAME(Name of Business or Owner Last Name) � 1�CX e • _ Wm w c)YlS
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
f. OWNER ( ) -
MAILING ADDRESS CRY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME CANT NAME OFFICE PHONE
CYO V.W\.ckre `- Ncr car) -e s c CA (?%oV,I- r (4S) '/< / -7(c67
CELL PHONE
MOIST;c 1213 m\\ C EK ON TE FAX NUMBER
s A ( ) -
I! 1 CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
v o%A , . DO-E3[., (`i2S)'ftI -goys"
NATION DATE E-MAIL ADDRESS
('V..-bW1J FPc)4' LL 4-`8.'egl jessicaecrowrfp cowl
I APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE -
�yo Wh c\Y�e' Wth-t -1:11, ( )
MAILING ADDRESS O. �IC. GJ� L Ak Ovt..+ � CITY,STATE,ZIP !ELL PHONE
A. € -
RELATIONSHIP TO PROJECT FAX NUMBER,
❑ Architect ❑Tenant ❑Agent ❑ Other ( ) -
PROJECT E PRIMARY PHONE E-MAIL ADDRESS
CONTACT , 11_04.0 C 4 ; - t• ' I_ OwV%►•• Oh'-
LENDER NAME Per RCW 19.27.095:
Lender information is required(f project value exceeds$5,000
MAILING ADDRESS CI Y,STATE,ZIP PHONE
( ) -
II DETAILED BUILDING INFORMATION c
EX=STII G USE yQ\\ Sc� - '�-e- -CA!\ PROPOSED USE 1\ cep ��. 'Ze \l
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ ��l'00.00
SPRINKLERED BUILDING? iitYES ❑NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES ❑ NO
WATER SERVICE PROVIDER ❑LAKEHAVEN ❑ HIGHLINE ❑TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑LAIEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED - TOTAL
SQ.FT. SQ.FT: SQ.FT.
BASEMENT
FIRST
SECOND •
•
THIRD
ADDITIONAL FLOORS(DESCRIBE)
•
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS I 'I° I reoros= I
N TOTAL Toni smra�+s. TOTAL PRO waosr TOT.cu
•
•
*VIEW HOMES ONLY" NUMBER OF BEDROOMS 1 ESTIMATED SELLING PRICE $ .
•
II 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.
MECUAMCAL •
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(commrdq
COMPRESSORS FURNACES RANGES
DUCTS. • GAS LOG SETS REFRIG.SYSTEMS
PLUIIFE G
BATHTUBS(srnb/samar ems* LAVS(Bathroom sink* URINALS MISC(Describe)
• DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(rasp •
HZ.ECTRIC WATER HEATERS SINKS WASHING MACHINES .
HOSE BIBBS SUMPS •
•
SIGNATURE
r 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 Wag 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.
r farther 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.
SIGNATURE: // DATE 24o.09
Property Owner and/or Authorized Agent
o NEW a ADDITION o ALTERATION o REPAIR a.TENANT IMPROVEMENT •
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a.YES a NO
•ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? o YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES o NO
Bulletin#100—January 1,2008 Page 2 of 4 k\HandoutsTennit Application