09-100831 •
O - L QL S3. _/_Fei eral
Wax,"AD PERMIT
COMMUNITY DEVELOPMENT SEM 0 5 200 SF MF CO ME EL PL DE EN
33325 3D8 AVENUE SOUTH•PG BOX 9718 LIGATION / /
FEDEwu y+►>y�° FE®E RA L
253 835 2 3 9
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The following is requi etr ormation-an incomplete application will not be accepted. Please print legibly(in ink)or type.
IN PROPERTY INFORMATION
SITE ADDRESS 3(be) .S• 4/ ' SUITE/UNIT# /10 T Z i D
ASSESSOR'S TAX/PARCEL# - ( f/ 2 v - 0 Z--2--/ LOT SIZE(s_j)
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 VFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
IIA STALLU ,i F i 'c 4LAZNt IMF ls1Ce 5 f-Ota TE/Ui—WT- //(4f eOUeMcn-)T
l% Comp Se,kke5
PROJECT NAME(Name of Business or Owner Last Name) A ": - - - . ;. „..__ ,
• PEOPLE INFORMATION
PROPERTY NAME
tv �
PRIMARY PHONE
OWNER 4 C DM ivt R cA� ,5 ti,t T(bS D u \( 31.-Dl) ( )
-
MAILING ADDRESS CITY, ATE,ZIP E-MAIL ADDRESS
3(e o 5. 3ifih 5t Frpp'fit w4-y,iutt,Ix101
CONTRACTOR COMPANY NAME i' , APPLICANT NAME OFFICE PHONE
(M ' (DNSTIR - , ; ( ) -
• :.DRESS CITY,STATE,ZIP CELL PHONE
cD 00 ; - :._ - . EA - (U A 43131-1 ( ) -
CO5CITY OF FE P ,t•• :• SS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
a- I -- 41 A `"ft: -;[. 12 31 Z_000 ( )
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
CCSWFP)(oCM Dec 3 t , Zc)9
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
Cdeco Fi2E? VLCC1t)'N 11-41-10o(N /OMN (4'25 ) P x'10 -b3
MAILING ADDRESS CITY,STATE,ZIP CELL PHON-E- l-
I5 tobP►ruvtt Rz.➢MoZDRD NG PPODINUIL(t i i CIW07Z.. (2b(o ) 5(9 13Z1
RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect ❑ Tenant ❑Agent ❑ Other ( ) -
PROJECT NAME� PRIMARY PHONE -f E-MAIL ADDRESS
CONTACT ,�l IRR.y L,t-(I•Fk (v.w ) Kii. - IZ I5”
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 $ 71 C'`-
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)
• •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
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(Tolle()
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 i I/ hich may be made by any person, including the undersigned, and filed against the city, but only
where such claim arises out of th ce of the ci including its officers and employees, upon the accuracy of the information supplied to
the city as a part of this applica
SIGNATURE: / •� DATE s/r3/6
Proper Owner and/or Authorized Agent
CIR »CEpVE flN)E.r
❑NEW ❑ADDITION ❑ALTERATION ❑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? ❑YES a NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100—August 16,2007 Page 2 of 4 k\Handouts\Permit Application