Loading...
08-102098 elito • ....t. RE CRY OF ..... o g 1._ a 2 Federal Way MAY 01 ZOOS PERMIT OMMUNITYDEVELOPMENTSERVICES SF MF CO ME EL PL DE Ei 25 AYENUESOUTH•POBOX 9718 ,ptvitATI ON FEDERAL WAY,WA 98063-9718 �C 253-835-2607•FAX 253-: - of G TU www.cit o ederalw•W, CD The ollowin• is re•uired i ormation-an incom•lete a••lication will not be acce•ted. Please •rint le•ibl (in ink)or . )T■ PROPERTY INFORMATION SITE �/ SITE ADDRESS I I -7.S v L (-{ LD' 1 1 `Dp1-�1 \JAY SUITE/UNIT#S P/ F H3 ASSESSOR'S TAX/PARCEL# i Co 2_ 7. ` -D Q-CI 0 I O LOT SIZE(sf) p(O 0 LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page:for lengthy legal description) • PROJECT INFORMATION TYPE OF PERMIT ❑BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM PROJECT S fl< Fd Ik work R this ESPRHI R JA I mPO ADD -ROD S Pi?INICLER_S ABC P E LOC:AT of HEAD,, PROJECT NAME(Name of Business or Owner Last Name) 5 B A R l?C II PEOPLE INFORMATION PROPERTY PRIMARY PHONE OWNER EAD FAST G®VI PAM I E ( ) - MAILING ADDRESS CITY,STATE,ZIP 343 VKI`l 1<ARMAN AVE SUITE3Y) NEI,IPDIZT BEACH CA 6171c60 CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE CDV() FIRE PROTELTIOff BRAN SCt-(ULZE (4Z5)8C7 -GIGS* MAILING ADDRESS CITY,STATE,ZIP CELL PHONE 15000 WCVDI I'{V I LLE REDr1CHD R() 1J1OODi NVILLE wA9,6 W1 ) - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER ,O 1'K (2 veD, EXPIRATION DATE FAX NUMBER Z D_ -.0 L-1 0 L $Q6/-9P- B 'LL L7(J' / / (465)cB3 -641 CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE o56 c2FP t ( c) Nd 12_ '31 '©8 APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE SAME AS ABOVE ( ) - MAILING ADDRESS CITY,STATE,ZIP CELL PHONE ( ) - RELATIONSHIP TO PROJECT FAX NUMBER ❑ Architect ❑ Tenant ❑Agent ❑ Other(Describe) ( ) - CONTACT NAMERj R 1 A Nl H U LL E S C -9654- E-MAIL ADDRESS LENDER Per RCW 19.27.095: Lender information is NAME required if project value exceeds$5,000 A MAILING ADDRESS CITY,STATE,ZIP PHONE IVA ( ) - II DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE ,{ 'MISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 40'00 SPRINKLERED BUILDING? AYES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? )(YES ❑ NO WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) 4 I PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT N/A FIRST e60 (D c) SECOND N/A THIRD N/A • FOURTH N/A ADDITIONAL FLOORS(DESCRIBE) M/�( DECK(COVERED?) A N/A DECK GARAGE ❑ CARPORT❑ EXISTING NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOT EXISTING SF TOTAL PROPOSED SP R>e)ir **NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ FIXTURES Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing factures to remain. MECHANICAL Value of Mechanical Work $ AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOODS Icommrrriag WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSElb rrouri) MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAYS(bathroom Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS DISCLAIMER/SIGNATURE BLOCK 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 filed 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. NAME/TITLE 13.,. ..L/a..40 / DATE 1/� J 29'-1 -5 (Signature) (Title) RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑Architect ❑ Other FOR OFFICE USE ONLY ❑NEW ❑ADDITION ❑ALTERATION n REPAIR ❑TENANT IMPROVEMENT BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? ❑YES ❑NO ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO NEW ADDRESS REQUIRED? ❑YES ❑NO UP/SEPA/SU? ❑YES ❑NO PLATTED LOT? o YES ❑NO DEMO PERMIT REQUIRED? ❑YES ❑NO Bulletin#100-January 1,2006 Page 2 of 4 k\Handouts\Permit Application