08-101531 cmof 4..... RECEDED fit, - l b_ ` 5_ 3 /
Federal Way
PERMIT
coMnl�mTrDEVELOFxEVrsERVlcES MAR 2 8 2 O' SF MF CO ME EL PL DE E FP
33325 8TH • BOX 9718 'p L I C A T I O N
FEDERAL WAY,WA 98063 63-9718 TD / /
253-www.c835-2607•FAX 25u�t ^n OF FEDERAL WAY
ittloffederal
The following is required infer lon-an incomplete application will not be accepted. Please print legibly(in ink)or type.
%� • PROPERTY INFORMATION
SITE ADDRESS `-' 'S 3 4- SUITE/UNIT#
1 _
ASSESSOR'S TAX/PARCEL# ` � ( I 2 b - 6 2 � I LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) V`1„WeA(s,
(Attach separate e for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING C9`FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
I Pnir C- s5 or- ( � ■Ce.RNA.IY\ ?v∎m V Wak( c lets r-- ks)alkt-ifics., 6
■
PROJECT NAME(Name of Business or Owner Last Name) ��V ,I�ri i V e,{5 \ `0„Mllloti l A. V- h u,1c( -
NI PEOPLE INFORMATION
PROPERTY NAME L^ . 1 PRIMARYP HONE
OWNER }��J y1� J�'1-n, -
MAILING ADDRESS ✓ CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COM ME IC• T NAME OFFICE PHONE
�� c)) ''"' lAW AA ( 4Z 0(o) €p 1'2.- "7(D192-
MAIplF RESS1 ` ,.I^ IG L5 CITY,ST'I ZIP GIB l o� CELL PHONE -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER J EXPIRATION DATE FAX NUMBER
CONTRACTOR'S REGISTRATION NUMBER EXPIRAT N TE E-MAIL ADDRESS
APPLICANT A APPLICANT NAME OFFICE PHONE
S C vY' ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑ Tenant ❑Agent ❑ Other ( )
PROJECT NAM E-MAIL ADDRESS
CONTACT I \n I Wt � � - q A��( Ub ) t3
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 $ r 1 Q-5 SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 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
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑ COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING Sr TOTAL PROPOSED Sr TOTAL Sr
**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 tcomme i4
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 lrmieq
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 p this application.
SIGNATURE: DATE 42-5\0
Property Owner and/or Authorized Agent
FOR OFFICE USE ONLY
❑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 ❑NO DEMO PERMIT
REQUIRED? ❑YES ❑NO
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Appt.
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