07-101637 CITY OF.. I Ci I 0 1,02 '' -
Federal Way:,ECEIVE
IIII PERMIT OF MF CO ME ELCDE EN FP
COMMUNITY DEVELOPMENT SERVICES
33325 8TH AVENUE SOUTH•PO BOX 9718
FEDERAL WAY,WA 98063-9748A R 2 9 2007A P P L I CATION TD
.253-835-2607•FAX 253-835.210 ` / _ -. /
WWII,.ah o ederrilwnu.com
T F RAL WAY
The following`A tT r5 tion-an incomplete application will not be accepted. Please print legibly(in ink)or type.
C S a PROPERTY INFORMATION •
SITE ADDRESS -✓( 'J(0 9- , • t)'" ,, SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# , c '7• Z 0 - 0 U 2- G LOT SIZE(sj)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING >'LUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT-,DESCRIPTION(Provide detailed description of work included on this permit ly)
;apl0-(..-te ,-)9 iu t ,t 5 ��C) rc%- ✓LS ��ei ve..M.-.
-mot
1 ; PROJECT NAME(Name of Business or Owner Last Name) 1,i ' A •
! I.PEOPLE INFORMATION
PROPERTY NAME ,IJ PRIMARY PHONE r7(�
OWNER V '•-k <�1r.0 C''y\ (y��-('i) 3y - C-
MAILING ADDRESS / .� CITY,STATE,ZIP E-MAIL ADDRESS
WI 0 --7'"`-.thi.e.. Svii 1--e,ie.-1-14 wo,AeigO23
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
( ) -
COPY of Dora required a,
CONTRACTORS REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
with each application I ,l
•
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
DUJ N-1 ( ) -
MAILING ADDRESS ' CITY,STATE,ZIP CELL PHONE
( ) _
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑ Tenant ❑Agent ❑ Other ( ) -
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT Ole, V- ( ) -
LENDER NAME , Per RCW 19.27.095:
1` /""4"'V'.--
" -V 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 $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPFION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
m AREA DESC- n• ON EXISTIN PROPOSED TOTAL
• SQ. FT. S•. FT. S s FT.
BASEMENT
FIRST
SECOND \
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
' EXISTING PROPOSED TOTAL TOTAL EXISTING Sr TOTAL PROPOSED Sr TOTAL Sr
NUMBER OF FLOORS
•
**NEW HOMES ONLY** NUMBEIP 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 E BBID 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
PLU1IJBING
/ BATHTUBS(or Tub/Showercombo) I LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS ' RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS / SHOWERS WATER CLOSETS{mite)
ELECTRIC WATER HEATERS I SINKS I WASHING MACHINES
HOSE BIBBS SUMPS
•
SIGNATURE
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. j ' 7 y /�
NAME/TITLE /11,, ! DATE _~2 I Jv
(Sitnature) (Title)
RELATIONSHIP TO PROJECT 'weer ❑ Agent ❑ Contractor ❑ Architect ❑ Other
.j
fir e? 8 ,a3. ,.. '
o NEW o ADDITION ❑ALTERATION o REPAIR ❑TENANT IMPROVEMENT.
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? ❑YES ❑NO
ZONING DESIGNATION CHANGE OF USE? ❑YES o NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? ❑YES ❑NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES ❑NO
•
Bulletin#100—January 1,2007 Page 2 of 4 k\Handouts\Permit Application