09-100576 �: D die - 766' 52(2
! Federal Way 3� —
COMMUNITY DEVELOPMENT SERVICES FEB 2 Zool'ERMIT SF MF CO ME EL PL DE E FP
33325 8Th AVENUE SOUTH•PO BOX 9718
FEDERAL WAY,WA 98063-9718 E E AT I 0 N
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253-835-2607•FAX 253-83b260A'y C r .c
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The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS 1 GI 3 3-S.i//, !1 _ a.'- • f • , SUITE/UNIT 4
ASSESSOR'S TAX/PARCEL# 5 1 5 2 0- 0 G es- LOT SIZE(sf
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach teara + )
• PROJECT INFORMATION
TYPE OF PERMIT ❑BUILDING ❑ PLUMBING ❑MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING IN FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onit))
4 _4,-K,: _ � i - t. UL — 6 _ i ',EZ� I eziIt ♦ rr
.;ti • • 2. cr Ze7)
PROJECT NAME(Name of or Owner Last Name) fr.:aPc6 S u cd-3 - • 110 1'
,mu PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER - ,� i_ • i S0 . .1 ' v ( ) -
ti V D T /- ittOr. CITY,STA,TE\SIP 9W13
LA-)
E MAAADDRESS
CONTRACTOR COMPANY NAME APPLICANT
NAME OFFICE PHONE
/ ..----
O ADD / CITY,STATE,ZIP CELL PHONE
U 6 o� . 6 L'. •� ��r d04 .z -G as-Y
CITY OF FEDERAL W BUSINESS LI ENSE NUMBER . . TION DATE FAX NUMBER
7 --./7-)'/,--5 1 _ .(1 l-aa �-- (va61 39y -�/3c
CONTRACTOR'S REGISTRATION NUMBER (/` EXPIRATION DATE E-MAIL ADDRESS
1 Fi/)/ 6---/6-A-- rJ •I - 21aa.-,n-c_ i-..3 --o /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
7-s i " [. - — - co- O< r-, . -P• /
0 'DRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect ❑ Tenant ❑Agent ❑ Other (`.2f) .37V- /J 34,
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT CthkL 6i.. T1 {� (as(a) e2., -LiC�9
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds;5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE /
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ ii) a.e O i 0 U
SPR NKLERED BUILDING? ❑YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQ ❑YES 0 NO
WATER SERVICE PROVIDER ❑LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
U PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DES a E)
DECK(0 COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS �ra0 r TOTAL=wO er TOTAL+ sr TOTAL IS
**NEW HOMES ONLY** I: OF BEDROOMS ESTIMA D SELLING PRICE $
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.
MECHANICAL
Value of Mechanical Work$ At COPY OP BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS .•RATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS F GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLA•'INSE ' HOODS(Co®.est
COMPRESSORS FURNACES RANGES
DUCTS GAS LO• • REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/$booarCona) LAVS(Bathroom Sinks) URINALS
MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS nu,)
ELECTRIC WATER HEA •+•.- SINKS WASHING 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 Way as to any claim(including costs,
investigation and defense of such claim), which may be made by any person, including the ' area a ag tts a city, b in the
where such claim arises out of the reliance of the city,including its officers and employees,upon and filed against ' only
the city as a part of this • ••lication accuracy f information supplied to
/ //
SIGNATURE: Imo iiii — DATE I -.3645-.3645 p
Property 0 •. and/or Authorized Agent
(
}
a NEW a ADDITION a ALTERATION o REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES o NO BASIC PLAN?
o YES a.NO
ZONING DESIGNATION CHANGE OF USE?
a YES o NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU?
a YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? o YES a NO
Bulletin#100—January 1,2009 Page 2 of 4 k\Handouts\Permit Application