07-104270 I . A REcEivec. (1117- _ / 0 4 0 - 7 CI
Federa'Way AUG PERMIT
COMMUNITY DEVELOPMENT SERVICES 0 2007 SF MF- CO ME EL PL DE EN FP
33325 8TH AVENUE,WA 9•PO BOX 9718 �p P L I C AT I O N TD
FEDERAL WAY,WA 980CyJ�$0F FEDERAL
253-835-2607•FAX 253-835-26;41w��+�
www.dtyo//ederalway.com.-- G DEg •
The following is required information-art incomplete application will not be accepted. Please print legibly(in ink)or type.
MI PROPERTY INFORMATION •
SITE ADDRESS 35530 J s r mit y coulti 1 ZrO 1 SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# CI 2 rP .D 0 - 0 LOT SIZE(sJ)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERINGA/
FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onll()
/tDi) Te) F.k4577 .c12V. 5 sT ,irl r Lfilk/e - ./.5e-p
PROJECT NAME(Name of Business or Owner Last Name) A' S- -r-I
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER 4'Q(06A-7- tfili n/C IAC- Sr't ltciS (2,5-3 )57-S- - O&OC
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
`g1 6 20 Z.3 fit $ 57f g (6014,4.c.+.„»-( 14_ 9,s-e,b3
CONTRACTOR COMPA"'• - - ( APP],II°ANT NAME OFFICE PHONE
PAC' cwze 1 c t1 /M 6RsT,v mtJ (Ze6 ) 75e - 38e*
MAILING AUUKt: CIT ) I• 'GA•/7L+t CELL PHONE
g 7,,r Ip pullet �wl'I .', ,, . WAY (2i* )34/ -90 lig
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATI• SATE FAX NUMBER
/7'"--
COPY of card CONTRACTOR'S REGISTRATION NUMBER EXPIRA ION DAT E-MAIL ADD ESS
with each a H'e � '�
po 1 0 1'50/o 7 Or ifrie,k,f3--.6 4
APPLICAN - COMPANY NAME APPLICANT NAME OFFICE PHONE
ts.1' ( )
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMB ER
0 Architect 0 Tenant 0 Agent 0 Other ( ) _
PROJECTPRIMARY PHONE E-MAIL ADDRESS
NAME�
CONTACT ‘6.4
S rM (z040)3q/ - 10'141 -6/see pFs.f 2-
LENDER
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 n/�
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ Of O(1/, II
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
•
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
S�.FT. SP.FT. Sf.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS RUSTING PROPOSED TOTAL TOTAL EXS7 NG SF TOTAL PROPOSED SF TOTAL SF
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
• FIXTURES •
Indicate number of each type of fvcture 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(commerdai)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SEIJ REFRIG.SYSTEMS
PLUMBING
BATHTUBS(orlub/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSE1b tro let)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
•
SIGNATURE
I certify under penalty of perjury that the formation 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 p emises to perform the work for which the permit application is made. I further agree to hold
harmless the City of Federal Way as,tan claim(including costs,expenses, and attorneys'fees incurred in the investigation and defense of
such claim),which may be made byi,' 1,including the undersigned,and filed against the City of Federal Way,but only where such claim
arises out of the relia • e 'rry yy ,. _officers and employees,upon the accuracy of the information supplied to the city as a part of
this application. ,,
NAME/TITLE
�/.�for c� (-07
DATE
(S p':I, et (Title)
RELATIONSHIP TO PROJE ❑ Owner ❑Agent ❑ Contractor 0 Architect ❑ Other
J
o NEW o ADDITION o ALTERATION ❑REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES ❑NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? o YES ❑NO
PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? o YES ❑NO
Bulletin#100-January 1,2007 Page 2 of 4 k\Handouts\Permit Application