09-101395 arras ' '! .- 41 i • 4_ _ / O • 3
Federal Way - PERMIT
COMMUNITY DEVELOPMENT SERVICES . ^�� SF MF CO ME EL PL DE EN%.,
33325 8TH AVENUE SOUTH•PO BOX 97181 2 v T
FEDERAL WAY,0FAX
98063-9718 71 8 APP_�/I C A T I O N TD / /
253-835-2607.•FAX 253.83-9718 Y
unvmatuo/Iederahuau.com FEDEki-L ifl,A
The following is required Volination-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS Sy25- 9 ) 5'4 Ave.. <W r-� SUITE/UNIT# 1
2 L
ASSESSOR'S TAX/PARCEL# 5 2 ( O 3 - I 0 O --- LOT SIZE(4)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal desafpton)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING I -MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERINGEL FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
l' 3
PROJECT NAME(Name of Business or Owner Last Name) L C,C, 1) �-t/
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER ( )
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
r0,7k ,ye eYoe iO4 )---nen k 5��t1�R S ti (2c6 ) 229 fie'5
ING ADD CITY,STATE,ZIP CELL PHONE
4% CITY/OF ms- fi 7 )e -- �� a- ` M Q ectz. (24A )229 -S-0/5
E WAY BUSINESS LICENSE NUMBER EXPIRA N D FAX NUMBER
r 0 '— l oz — oma t z 3t o5 ( ) -
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
--r r_7,,r.lk 979 "rs 2-a2 -.2 61p
APPLICANT COMPANY NAME„(....srI�
' +7 APPLICANT NAME OFFICE PHONE
<'5,/\ Q� ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑ Tenant ❑Agent 0 Other ( ) -
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
U DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORD )4 Op' `'a j
SPRINKLERED BUILDING? o YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES a NO
WATER SERVICE PROVIDER a LAKEHAVEN 0 BIGHLINE ❑ TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN a HIGHLINE ❑ PRIVATE(SEPTIC)
•
PROJECT FLOOR AREAS.
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
(
EXISTING PROPOSED TOTAL TOTAL=SITS°sF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
"'NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offuture 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(commerJog
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 roe fro,kg
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: ✓fesic DATE y-/5 -O
d Property Owner and/or Authorized Agent
a NEW a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES o NO BASIC PLAN? a YES o.NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—January 1,2009 Page 2 of 4 k\Handouts\Per iit Application