08-104238 1
or- tO.."4. 23r
Federal Way PERMIT Igo F CO ME EL PL DE EN FP
COMMUNITY DEVELOPMENT SERVICES
333258THAVENUE SOUTH•PO BOX 9718 APPLICATION S lo / ce
FEDERAL WAY,WA 98063-9718
253-835-2607•FAX 253-835-2609
www.cituoffederalwau.com
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS IC t `'.1 L � C�(� '1 CC S f� ��y ,„ SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 4 l 5 (0 .2- 0 -Pv 6 `� LOT SIZE(s,))
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) + (0
(Attach pate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT .W' UILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu) r
ctbeja
� e r --- .sf-t''-tom .-e.-C". .
PROJECT NAME(Name of Business or Owner Last Name) L a'1
/
1111 PEOPLE INFORMATION
` PRIMARY PHONE
PROPERTY NAM k ll C c jeZ,, ( I ARY. ) 51'1_ _5tiC4
%
OWNER ��if�JjU�\ V tJ►E)`-' 17 tJ
MAILING ADDRESS �'L Y
Ate, E-MAIL ADDRESS
(ct vL I 353 5- k.e.c e (aX'� Ora
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
-<Bt-rn ( )
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
( )
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
APPLICANT COMP 0APPLICANT NAME OFFICE PHONE _
(
MAILING ADDRESS CDT,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
o Architect 0 Tenant ❑Agent 0 Other ( )
PROJECT NAME ^ �r PRIMARY PHONE E-MAIL ADDRESS
CONTACT ®�t/ '" • (i2 C(. ) 'l - 9;:,2.,: -7
LENDER NAME / Per RCW 19.27.095:
0 .'4) Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE 44idekidiT /�1,/ PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ 99/ ( t/ `.) VALUE OF PROPOSED WORK $ _ I CO C3
SPRINKLERED BUI DING? ❑YES ❑NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES ❑ NO
WATER SERVICE PROVIDER 1:LAKEHAVEN o HIGHLINE • - -._.,,,._ • • • ATE(WELL)
• SEWER SERVICE PROVIDER o LAKEHAVEN o HIGHLINE -PRIVATE - • ' C)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST y 1/4Q
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR 0 UNCOVERED?)
2
--
GARAGE gr fARPORT FS � Z/ 43
1-9 row— plow 4-1-6
EXISTING ` V
TOTAL SBBTLVO SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
• FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project Do not include existing futures 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)a mme,uofl
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS)orTub/Shower Combo) LAVS(Bathroom SW.) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(rouet)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify under penalty of perjury that I am the property owner or authorised 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 authorised 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 Wag 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 this application. q
SIGNATURE .%''- DATE �I - 0 - O
-rtyOwneerand/or Authorized Agent
FOR OFFICE USE ONLY
❑NEW ADDITION ALTERATION o REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES kNO BASIC PLAN? ❑YES )4NO
ZONING DESIGNATION 2 - 't-'. $F(-1 D) CHANGE OF USE? ❑YES )(NO
NEW ADDRESS REQUIRED? o YES NO UP/SEPA/SU? ❑YES "(NO
PLATTED LOT? )cYES o NO DEMO PERMIT REQUIRED? ❑YES /NO
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application