07-106132 RECEIVE - 104 � 3 -
ederalWay 8 PERMIT
COh1MUNITYDEVELOPMENT SERVICES NOV 0 2007 SF MF CO ME EL PL IDE EN ow
33325 8TH AVENUE SOUTH•PO BOX 9718 "-"- -- ---- -- ---- -
FEDERAL WAY,WA 98063-9718 TD
253-835;2,607.FAX 253-835-2609 jITY OF FED LICATION i / / „ e% / --
www.dtueffederatwau.com BUILDING DEPT.
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
UNI_ PROPERTY INFORMATION
3 Pa_ CC Jy $SITE ADDRESS ),:g...)....5--
SUITE/UNIT# /(3
ASSESSOR'S TAX/PARCEL#
LOT SIZE(sD /lc /!
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING )4 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
5-'AI( /1 VA o vi5o.J Y10 ' tcw ca„_ deuRceS Foe_ F L6.—\.,cJ`vtn_ Sys4ern
PROJECT NAME(Name of Business or Owner Last Name) YVk okoa..1 I U (J`t Q'
• PEOPLE INFORMATION
PROPERTY l NAME PRIMARY PI IONE
OWNER I 11,41,..._ �in.LJ'4'v�nt.r��S_.. (53 ) 91=3 =o0�-yr_.
MAILINGrADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
I
111 5.4). Lam- l4 S SSD Por�b,.� ,o(t.. 9 9 3 v�1
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
PQ'eCZ.5t 044LAA� k�,...C-. �•asa d $Oc> - .5-VF- /Y/(o _,_
o^MLAIILL_IING ADDRESS1��1��•• `�C� lnCd` ,,/�` CITY,STATE,ZIP CELL
LrrnorIE
CITY QF FEDERAL AY BUSINESS LICENSE NUMBER e0`�''t�t,L EXPIRATION DATE ( NUMBER
3 9rY - 4O99
Cl-1 g-R,Oooc�/N-00 S REGISTRATION Bial-. I ER 13l TIO ATE (353E-MAIL )?.3.5- cle
DDRESS
P(Z' .0 Lg-L-c)?.-Li Q•0 .. . QlRe.Sysa- , +
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
Peer tCNCk .. CKNe6"14. t_i c'. G\,•,.st. G1e« .. -s 400 ) SYfr -/5'/6 --
M ILING ADDRESS CITY,STATE,ZIP G,,.,.,.dONE
._1X9 FR�071-1°47 U t
i1. Qa .44.` , (....iia-. _ (153 19r-if _609q
RELATIONSHIP TO PROJECTFAX NUMBER
0 Architect ❑ Tenant ❑Agent vf Other e.c.,,,.L,r6.,1ee(� )?3r C u3
PROJECT NAME PRIMARY PHONE SE-MAIL ADDRESS
CONTACT CL-5C '^- (`7.S3 ) 9s-ti - 6.0 ILJ^ r��steM—., ow-
________
LENDER NAME Per RCW 19.27.095: —�
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP 1 PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
43614-__,-
EXISTING ASSESSED/APPRAISED VALUE$_ VALUE OF PROPOSED WORK $ _^ _—
SPRINKLERED BUILDING? Li YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? I I YES o NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ TACOMA Li PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE t I PRIVATE(SEPTIC)
may,.' • PROJECT FLOOR AREAS '
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ. FT. SQ. FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
a 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 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 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 this application.
SIGNATURE: Cl'dre... DATE
Property Owner and/or Authorized Agent
FOR OFFICE USE ONLY
NEW ❑ADDITION u ALTERATION ❑REPAIR u TENANT IMPROVEMENT
BUILDING SHELL ONLY? u YES ❑NO BASIC PLAN? ❑YES LI NO
ZONING DESIGNATION CHANGE OF USE? u YES a NO
NEW ADDRESS REQUIRED? a YES o NO UP/SEPA/SU? YES NO
PLATTED LOT? n YES i_i NO I DEMO PERMIT REQUIRED? u YES a NO
•
Bulletin#100—August 16,2007 Page 2 of 4 k\Handouts\Permit Application