10-103459 0
CITY OF •.^ ''' 1111Z-- �� i
d
Federal Way 1. 1:4°
�°IPERMIT
AUG SF MF CO ME EL PL DE E FP
COMMUNITY DEVELOPMENT SERVICES ,,,..,���111 �;;,
333258THAVENUE WA BOX 9718 F ' 'LI CATI ON / / `�
FEDERAL WAY.WA 98063-9718 r
253-835-2607•FAX 253-835-2609
www.cdualiederalwau.coa�i Q ,ws
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
G� / _ • PROPERTY INFORMATION/ 1
SITE ADDRESS_ �/ L D 6/n W fil C 7 66/41 �f t/4 SUITE/UNIT#_
ASSESSOR'S TAX/PARCEL# C� / �j ( V- 3 A 0 LOT SIZE(s�
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page f r lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING SIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
/lad Ivk+ et I F(e)C4-4 I,:k,, S.�,C/A1 VIC:" its IV E'«5'Sit9'Y A-O K
S.>'.1-IC ZO.61y itb ,PN,O VA—f�6A.) .
PROJECT NAME(Name of Business or Owner Last Name) 1. Ufe..J>//¢-/CQ by W/ // !` -Q.(H',i amy
• PEOPLE INFORMATIONPROPER11
OWNER TY NAME d A l `\SS FLO ( )PRIMARY PHONE -
MAILING ADD SS C ST TE, E-MAIL ADDRESS
thicia
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Noce41w60-f 6:1( Sys rS eOfraZ 4 (2s4 )77z -75oZ
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
33/5 5. //G 7" Sfi It !IS- 7Zte�t(-I4 044. 9f/6e (Zs4 )375 -!3a%
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
Zo -/0 - lbI4Z"7 - DO - BL (204 ) 774 - T5o4'
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS tj W�.0�
NOS CS riz t c g aIL7L -7 ) tps S 5- ,..5 .C6rn
APPLICANT COMPANY NAME y// /�y^Jy v�jOLR/ANT N OFFICE PHONE
MAILING ADD SS � CITY,S I CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑Tenant ❑Agent ❑ Other ( )
PROJECT NAME �,p/' //,��__.. ` PRIMARY PHONE q E-MAIL ADDRESS
CONTACT 5E i'o L a-2o� (qo 7 ) 733 - Mei 1
LENDER 7 NAME Per RCW 19.27.095:
A
Lender information is required if project value exceeds$5,000
MAILING ADD CITY,STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION �/�
EXISTING USE /161C. _�iPROPOSED USE ,% CL
414.
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ Z, & )•
SPRINKLERED BUILDING? YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES o NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE o TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER o LAKEHAVEN ❑ HIGIILINE ❑ PRIVATE(SEPTIC)
•
0 41111
` . PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED ) TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST 26 `� cpry c( 2,,v,,,
A L � 0 59)14 C� S/»44 ---
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
**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 STIMATE MUST BE INCLUDED WITH APPLICATION)
AIR ..IDLING UNITS EVAPORA 'COOLERS GAS PIPE OUT.ETS WOO OVES
B 5 DS FANS GAS WAT r HEATERS C(Describe)
BOILERS FIRE' 'CE INSERTS HOO D.:(Commercial)
COMPRESSORS F.' ACES ES
DUCTS GAS LOG SETS ' FRIG.SYSTEMS
PLUMBING
BATHTUBS( Tub/Shower Combo) LAVS(Bath m Sinks) URINALS MISC(D ribe)
DISHWAS RS RAINW ER SYST VACUU REAKERS
DRIN G FOUNTAINS SH ERS WAT CLOSETS(Toilet)
IC
_ E TRWATER HEATERS KS W SHING MACHINES
SE 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 . the ci ,'''in
in ing its officers and employees, upon the accuracy of the information supplied to
the city as a part of this applica '.
� %//_�r� P lD ''/D
SIGNATURE: �I� DATE
Prope Owner and/or Authorized Agent
FOR OFFICE USE ONLY
o NEW o ADDITION o ALTERATION ❑REPAIR E TENANT IMPROVEMENT
BUILDING SHELL ONLY? YES r;NO BASIC PLAN? ❑YES Li NO
ZONING DESIGNATION CHANGE OF USE? a YES c NO
NEW ADDRESS REQUIRED? YES ❑NO UP/SEPA/SU? r YES i NO
PLATTED LOT? o YES NO DEMO PERMIT REQUIRED? =YES NO
Bulletin#100-January 1,2008 Page 2 of 4 k\Handouts\Permit Application