08-103563l
, ..:� EC1 1Vil' ( - / 0 3 s &._?Federal Way PERMIT — —
COMMUNITY DEVELOPMENT SERVI¢j 2008SF MF CO ME EL PL DE E FP
33325 8.AVENUE SOUTH• APPLICATION .n,
FEDERAL WAY,WA 9806363-9797 18 / /
253-835-2607•FAX 253-83_5,�-2609
www.citucOF FEDERAL WAY
The following is require n nation-an incomplete application will not be accepted. Please print legibly(in ink)or type.
c • PROPERTY INFORMATION
SITE ADDRESS sg'&".5S f"p CCC t -Is L- /h L)c S. SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# G y 0_a j 9 - _L f n LOT SIZE(s) .234 q$a
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for Iengthg regal deseriptioN
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑'ELPLECTRICAL ❑ ENGINEERING ❑-IRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description owork included on this permit only)
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PROJECT NAME(Name of Business or Owner Last Name) Wesie I n Tr‘Ve-c4 –c k e Fee a✓e r D.C..a.ree.►4_,_
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER A) ( k lc,c; LL ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
a 7 C. eGtnC i' ,arc SF Vc.r\C LJA `r,`aG
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Ever ce I, re 4-&•��,�: 1-%/\8.SC� Lis l i p'�(.)53 )6 27 3 `/
MAI3c1( AD S ICW,STATE,ZIP S-- I -`_I,S /'_i.6 1v�G` ✓'1 { .7 (ELL PHONE -
a Oo FEDERALo 3 AY-BI CO UCEIS,Sd NUMBERa U 2`LSC 14 T 7 FAX NUMBER
(as31)6?7 - 77 c 7
CORACTOR'S REGISTRATI N NUMBER` ERPIRATI N DATE E-MAIL ADDRESS
eVE K6FASLG ‘//c5-,r 6 ,Slic. 0,==vef-cil- P
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
ale C c--v\--6---c-47, ( ) -
NG ADDRESS CITY,STATE,ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant o Agent 0 Other ( ) -
PROJECTAME �^1 PRIMARY PHONE E-MAIL ADDRESS
CONTACT AME
Nl i C- C]'1 e l 1 ow„_C ( P53) 6.72 -3""? y
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE 3 3 ci Z'
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? n YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER C LAKEHAVEN o HIGHLINE ❑ PRIVATE(SEPTIC)
• PROJECT FLOOR AREAS
• AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST7,3
SECOND 3b- 7J n� Cj(-
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
EXISTING PROIY)6EDAI. TOTAL EXISTING SF TOTAL PROPOSED SF
LO T/7 �
NUMBER OF FORS !/��'/�
ir
**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 UNI'T'S EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERT'S HOODS(commemiap
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(orTub/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toilet)
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 part of th'.. application.
•
SIGNATURE: //�_ / — DATE
Property Owner and/or Authorized Agent
FOR OFFICE USE ONLY
NEW n ADDITION n ALTERATION n REPAIR TENANT IMPROVEMENT
BUILDING SHELL ONLY? n YES n NO BASIC PLAN? n YES n NO
ZONING DESIGNATION CHANGE OF USE? n YES n NO
NEW ADDRESS REQUIRED? YES n NO UP/SEPA/SU? n YES n NO
PLATTED LOT? ❑YES n NO DEMO PERMIT REQUIRED? o YES n NO
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application