07-104462 r
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Federal Way tL�7`r}, PERMIT LI
COMMUNITY DEVELOPMENT SERVICES °11�U 200? SF MF CO ME EL PL DE EN 0
3332E D AVENUE SOUTH•PO 9 9718 $ ,LI CATI O N
FEDERAL WAY,WA 98063-9718 TD / /
253-835-2607•FAX 253-835-2609 Y OF FEUD
www.cihtoffecieralwau.com
qui' DEPT.
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS_ (-.7e/'..576y'-4--- 4i/g- 5 SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 2 d 0 V 6 / - 0 0 c7� _0 LOT SIZE(sj)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING )FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onit1)
/7(T2'. FL/in.-- [ .ii . '�YS fc'L... jc �/2Pc�� SSC�1�-x +'/G' �?t,�
ILI LcV/iw, c , y6/77.0-r-/. t- '✓_ �1c1 "7, -
PROJECT NAME(Name of Business or Owner Last Name) �( r r. C(s 1cy�(Til..- 1 c��(� APO
I. PEOPLE INFORMATION
PROPEOWNERRTY N ,'—Z J i `!/ /-'&pt 7( ;y -_4�i-i`s- PRIMARY)HONE
17 5 � c/ .—MAILING ADDRESS CITY,S,�C�.e�l�?A lig 9 •*c P E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLIC• T NAt91E� — OFFICE PHONE •
:t1,4`'tea° et&/4049 Mit t t, illoc/ ,S06. 1 teR&) ,tt- '- / 7ç�
MAILING ADDRESSjit. CI ATE.ZIP CELL PHONE
...e.:_..�77 NIM.virarr.e ,, .i s— " w ✓r I' t arNG�'i)s72{5S- yr7 ,t7
CITY•�`FrRAI4r y USINF.SS L}�rFj11 NUMBER C 4F{PIRA CO.421.1 •le, FAX NUMBER -
COPY of card required ,�r� CONTRACTOR'S REGISTRATIONIS `A ' NUMBER EXPIRATIONDATEE-MAIL ADDRESS
with each application `!j
COMPANY NAME
OFF
CE PHONE
APPLICANT lil� ►-2'lcl 1.1L of �V I I Li( 4t --3
3 C 14NAME �4r p �✓�. ( .�I;'G o z(G' '``'N Z 6 Y'
YMI11LI/N 4DRESS l c�� CITY,�, STATE.ZIPq T q CELL PHONE
yK/ CTC- /4-4. c°lrr) 7-`)--C - �S IS"
RELATIONSHIP TO PROJECT 2 NUMBER
❑ Architect o Tenant ❑Agent Other t3CCIA Get 'Cee ( ) _
PROJECT NAME P Y PFl NE�.j 7 COMAIL ADDRESS
CONTACT Y jl 11 ( V(JI e ( ) - Lf(izl
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
■ DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
/f/� /
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 11,--ifer '
SPRINKLERED BUILDING? q YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
' • PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
S9. FT. SQ. FT. SQ. FT.
BASEMENT
FIRST
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 offixture 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 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
PLUMBING
BATHTUBS(or Tub/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 cert(fy 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 premisgs 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 'ty, i ing its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE 7,.////16t ) r?
/ /1 Le(..Y_ r/,1. DATE f.i y
(Signature) (Title)
RELATIONSHIP ,4:6EECT 0 Owner n Agent ❑ Contractor 0 Architect '7Other ,5(36-AG.2 CG•2 4L
FOR OFFICE USE ONLY
❑NEW o ADDITION ❑ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? ❑YES ❑NO
PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? ❑YES n NO
Bulletin#100—April 2,2007 Page 2 of 4 k\Handouts\Permit Application