06-105424 •
CITY OF • .6 —
/ L
. Federal WRECEIVED PERMIT -S-- (-( 2— (E
COMMUNITY DEVELOPMENT SERVICES
SF MF CO ME EL PL DE ENO
33325 8TH AVENUE SOUTH•PO BOX 97]8 To
253D83S-2607•ERAL YFAX 253-835-
1
53 835Y669T 2 4 zoos APPLICATION- ,.
www.mtyo(federalwa4.com'' f' -/
The followin9)i �b Mini tebY.-an incomplete application will not be accepted. Please print legibly(in ink)or type.
U1lLU�II VVV NI PROPERTY INFORMATION •
•
SITE ADDRESS !„ .,..,� - AV:vJ ''
re' _L'� / ' SUITE/UNIT# /
ASSESSOR'S TAX/PARCEL# / S 0 0 g - 0 ' 1 0 V LOT SIZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates, Lot 1) ,CSrk,„f.c 4%/'rGL.s- (4.1 C.e
(Attach separate page for lengthy legal description)
• ■ PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
0 DEMOLITION 0 ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
cid S 5oiakes 0 /60y1)/s74,06-,s
it
I Q
PROJECT NAME(Name of Business or Owner Last Name) b /SY'ie't h 6, t✓�J f 14'►4'
•
• PEOPLE INFORMATION •
PROPERTY NAME / , y/ PRIMARY PHONE
OWNER r.�YSt:� V�C I-/� ( )
MAILING ADDRESS( x 7.--)08 Cf ,STE,ZIP a,1 E-MAIL ADDRESS
//i/Y`IV "DLJ e
CONTRACTOR COMPANY NAME ,,/ J _ Alc.
ANT.1,21 ilE - OFFICE PHONE t�
E Y4K21 L�fU�-iG+�. Js'+r�.tc,� /C�'\ /- !r!U _(1 z.] )-7Y2-. c
MAILING A RESS CITY,STATE,ZIP CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER - - EXPIRATION DATE 'Z,.sit' FAX NUMBER
3bitSZZ ?a-0 ( )
• COPY of cud required CONTRACTOR'S REGISTRATION NUMBER��'""" EXPIRATION DATE E-MAIL ADDRESS
with each application I > /E. 0-3 5 t r f ["`O�-V,
APPLICANT CO PANY NAME S ,`` • APP NT NNJA OFFICE PHONE
t om- �. dec. vrcd+(&vuis� ' � �� ( ).�4-Y -
MAILING A RESS CITY,STATE,ZI CELL PHONE
15T 3 6 3 e__ e,t C144-15. , (-te4 y9 .o (a-06 ) e 1 - sYYel-,
RELATIONSHIP TO PROJECT . FAX NUMBER
0 Architect 0 Tenant ❑Agent 0 Other (�er )',C,� -A'7t.
PROJECT NAME) PRIMARYFFP TO/NE E-MAIL ADDRESS ,,, /�
CONTACT ('bin �U1 g°6 )?C, i -� hi-... �!?/)OLu^Ph1t4/` s
&Acy9.G�lw
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
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 3 5 0 0-o
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER o LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
• • PROJECT FLOOR AREAS
AREA DES• • ION EXISTI` PROPOSED TOTAL
SQ. FT. SQ. FT. SQ. FT.
BASEMENT
FIRST
SECONDi -- -
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT CI
EXISTING OPOSED I TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**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 UNITS EVAPORATI •COOLERS AS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE I .ERTS HOODS(commerefal)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SET. REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) •VS(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 ,. ...w
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, upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE DATE /0 Z `(-(D
(Sign ture) - (Title)
RELATIONSHIP TO PROJECT 0 Owner Agent 0 Contractor 0 Architect 0 Other
R k Gl j S AM4, I,: .
❑ NEW o ADDITION ❑ALTERATION o REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? 0 YES ❑NO
ZONING DESIGNATION CHANGE OF USE? ❑YES o NO
NEW ADDRESS REQUIRED? o YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? ❑YES n NO DEMO PERMIT REQUIRED? ❑YES a NO
Bulletin#100—January 1,2006 Page 2 of 4 k\Handouts\Permit Application