10-100129 ....
, i CITY _ - 1 D C2 i a. 1
FederalVV �CEIV
PERMIT SF MF CO ME EL PL DE EN FP
COMMUNITY DE E SOUTH•P SERVICE N A..2 (p l j\P P L I C AT I O N TD
33325 STj+AVENUE SOUTH•PO BOX 9
FEDERAL WAY,WA 98063-9718 / /
253-835-2607•FAX 253-835-2609
www.ciho e FEDERAL, WAY
The following is requirecifittfvlLmation-an incomplete application will not be accepted. Please print legibly(in ink)or type.
I 4Li��rr�� IN PROPERTY INFORMATION �+
SITE ADDRESS 3(iDO "vat a 1 +4 $f ( V►`- L )t 1 -1 Wit- 'evo/ SUITE/UNIT# I ` a
ASSESSOR'S TAX/PARCEL# '? � (a / 2--"O -
O 7, e.---/ LOT SIZE(sfi
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) //C) f
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
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)
FIRE I L-f P- . T okt -me NOQ-(f-c—A St4& OF FAST Rso R -
i y/, zird kkLSfl'icZ5
PROJECT NAME(Name of Business or Owner Last Name) AG 7 LW Pu0012-- I ‘.1 13L4)6.-
II PEOPLE INFORMATION
OWNER PROPERTY NAME_ P P A-� N Fir A., A C O 4C . AS3Y) 8'7 ,37S
MAILING ADDRESS �[ sr CITY,STATE,ZIP E-MAIL ADDRESS
3 oI541 3�'�(f" emLwfly(wRc4&'c
CONTRACTOR COMPANY NAME / APPLICANT NAME OFFICE PHONE
COSGo FiAe re..oc'6o4 be buyq 00-5T (086 -63x0
MAILING ADDRESS CITY,STATE,ZIP CELL PHON
ZCvo0( AlklVILLX geDER-gel) - vicot bVIIIE Dklff'o7L ( L 764 ! 905'
a•o-ot - tote "- oo -sL la -3t — a•'oto (14-.)44119 - 614,?S
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
ciP.SCc F p R3 5*4 S `1-a. -9-0(1 2 d4t4lf.p re-cow.-
APPLICANT COMPANY NAME 91 'V APPLICANT NAME OFFFICEE PPHONE
MAILING ADDRESS RELATIONSHIP TO PROJECT ttt"`"'111 !!! FAX N'UM_BER
❑ Architect ❑ Tenant ❑Agent Other Go g(� b pg ( ) -
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT a t) oor' ( -b-SI tog(p - (0 3 oo emood ye re. .ap*,
LENDER NAME Per RCW 19.27.095:
Lender information is required(f project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
-�j 00
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ !/t'Ob
SPRINKLERED BUILDING? YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
1
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST _4 1 0 X7 O
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED 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$ (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(Commercial
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS or Tub/shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toilet)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
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 a part of this application. /I /
SIGNATURE: _ L v✓ DATE 1` —I O /0
v
Property Own- . d/or Authorized Agent
n NEW n ADDITION n ALTERATION n REPAIR n TENANT IMPROVEMENT
BUILDING SHELL ONLY? n YES o NO BASIC PLAN? o YES n NO
ZONING DESIGNATION CHANGE OF USE? n YES n NO
NEW ADDRESS REQUIRED? n YES n NO UP/SEPA/SU? n YES n NO
PLATTED LOT? n YES n NO DEMO PERMIT REQUIRED? n YES n NO
Bulletin#100—August 16,2007 Page 2 of 4 k\Handouts\Permit Application