04-100145 RESUBMITTED FP
IrCOMMUNITY DEVELOPMENT SERVICES
JAN1 6 2DQ&FIRST WAY SOUTH•PO DERAL WAY,WA 98063-97189778
Federalay PERMIT APPLICATION 253-661-4115.FAX:www.dttof[ederalwallC"253-661-4129
TD:
For Office Use Only: FW File Number: Q (E - 1 C2 0_ I t- F e /
The ollowin• is re•uired in ormation-an incom•lete a••lication will not be acce•ted. Please •tint le•ibl (in ink)or .
■ PROPERTY INFORMATION
3/ . S-3 f
SITE ADDRESS: / g`i � LV� �/fir( r SUITE/APT#
ASSESSOR'S TAX/PARCEL#: - SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTION (eg:Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT(This application): 0 BUILDING 0 PLUMBING o HANICAL 0 DEMOLITION
ELECTRICAL 0 ENGINEERING IRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed des P�tion of work included on this permit nit):
PROJECT NAME(Name 0 Business/Owner Last Name): A vet, . , I e 1
■ PEOPLE INFORMATION
PROPERTY NAME: .'Jj�� PRIMARY PHONE:
OWNER �f i/. ( ) -
MAILING ADDRESS(STREET ADDRESS;: CITY,� STATE,ZIP
CONTRACTOR l,,r..�NAME r` ` MPANY OFFICE PHONE:
;dre., A rec./4?-1:p
MAILING ADDRESS(STRR ET ADDRESS;): CI AT,EE,,/ZIP CELL PHONE: ���-
CIT OF
3)9-i?
WAY B Gf cW��E NUMBER: t eI'S l X TI DATE:/ �AX NUMBER: 3)
-
_ _ / / ( ) _
CONTRACTOR'S REGISTRATION NUMBER: - EXPIRATION DATE:
• (copy of card required with each application)iLy L„..
E^ 4 F Cr e ; IV P R JO /) 9 / 0 j
LENDER NAME: DAYTIME PHONE:
(It Proposed Value>$S,000I ( ) _
MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP
APPLICANT: NAME: COMPANY OFFICE PHONE:
( ) _
MAILING ADDRESS(STREET ADDRESS): CITY,STATE,ZIP EVENING PHONE:
(
RELATIONSHIP TO PROJECT: FAX NUMBER:
0 Architect 0 Tenant 0 Other(Describe): ( ) -
CONTACT PERSON FOR THIS PROJECT: 0 Property.Owner 0 Contractor D Applicant E-MAIL ADDRESS:
■ DETAILED BUILDING INFORMATION
EXISTING USE: PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $ /DD. 4,e)
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: a YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ. FT. TOTAL
BASEMENT I
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
**NEW HOMES ONLY** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ FIXTURES
Indicate number of each type of fixture that is to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
—BBQS FANS HOODS(commerciat) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS or Tub/Shower combo( SHOWERS WATER CLOSETS(Tolle) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYS
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sulk VACUUM BREAKERS ELECTRIC WATER HEATERS
■ DISCLAIMER/SIGNATURE BLOCK
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, port the accuracy of the information supplied to the city as a part of this application.
NAME/TITLE: DATE: /1/a,
(Sil..tur (Titki
RELATIONSHIP TO PRO 0 Property Owner a Applicant 'Contractor 0 Architect a
FOR OFFICE USE ONLY
a NEW o ADDITION ❑ALTERATION ❑REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES a NO BASIC PLAN? ❑YES n NO
ZONING DESIGNATION: CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? ❑'YES ❑NO UP/SEPA/SU? ❑YES ❑NO
PLATTED LOT? o YES ❑NO DEMO PERMIT REQUIRED? a YES ❑NO
1 it.uL t lt;:
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