08-100231 CITY OF..`P'•.""'.,,,nr.i' D -
— 6 0 _a t_
"Federal Way _ „*u PERMIT :A
COMMUNITYDEVELOPf , SF MF CO ME EL PL DE EN (�P
t 33325 FEDERAL
WAY,WA 8e APPLICATION - - "''
FEDERAL WAY,WA 98063.9718 7p
253-835-2607•FAX 253435.2609 4L 2.008
/ /
vmiw.cilr of ederalwny m JAN
• The following is required , n WPNcomplete application will not be accepted. Please print legibly(in ink)or type.
.- ...■ •PROPERTY INFORMATION • •..:
SITE ADDRESS tet0 5 . 32oT14 S,-, SUITE/UNIT# 2 3,4
ASSESSOR'S TAX/PARCEL# 0 9 Z. ) O L4 - q Z c=> a LOT SIZE(sr)
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LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) .
(Attach separate page for lengthy legal description)
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• : ■ PROJECT INFORMATION . .
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL
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0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING R,FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
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ADC/Z�t_OCfeTJ_ HEADS AS C£ Csz tLI r-2 •>;DCL nt6t.1 %A/At-LS Altt> CC.ft_/NGS or=
oV vJ TENANT IMPRoult M& .NTS
PROJECT NAME(Name of Business or Owner Last Name) 4ME2/G4'S BEST caNt.4GT5- .44.42> 'E YE.: U LASS, C
■ PEOPLE INFORMATION
PROPERTY NAME . PRIMARY PHONE
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OWNER • ( )
iMAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
PAT 214 T— Fi2E P2oT6L;r!onlJ/"/C--", MAS—
• (2.53 ) 9Z6 - 29
MAILING ADDRESS CITY,STATE,,ZIP P N Zo
CELL PHONE
2701 701-'4 AVE. F . rAcoMA,_ Wil 96L zq .(25'3 ) 4344 - 31/74
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
(253 )122 4.15-0
copy ore.ja regalT<a CONTRACTOR'S REGISTRATION NUMBER -- EXPIRATION DATE E-MAIL ADDRESS
wOI: each applleation I > -
PA.-r re. I F P o et g C F I o/s-/db Yn41
y 6 46t r k of f,rr•.c oM
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
PATRIOT FIR C--- PRoTEc77IoN , AAkTc- V REeM (ZS3 ) ct .h
z-6 - ZZo
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
Z.70 7 76T-14 ,.4lig .E • TAC. 4 1 vV� 9 8 4 2-c1 • (Z.5-'s )at Li - 31/79 .
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑ Tenant ❑Agent M Other SOS•contTlz Aerate, (Zs-3 ) d Z Z_ - G.l,5"—en
PROJECT NAME - PRIMARY PHONE E-MAIL ADDRESS
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CONTACT • I ( )
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
• MAILING ADDRESS CITY,STATE,ZIP PHONE •
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• ( )
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■=DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ - VALUE OF PROPOSED WORK $ 1, 14 5-3 . c'O
•PRINKLERED BUILDING? DY YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO -
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
x P ;a s.'M.4}1 F'-'••.:.:.`ixs l ciF:rr.k •:Ns y_ yea: •n v r• • • •1-4 ) • d..,?.ri,.'p
.k $t ' h ; f az'-w.tr.:.....s.c a:..;.•••ertt'I2 ,.. t + �� t1; .'.t' '
?h;.;.•{w�� ii.ieiai.fr ;•sY.rKfpzi. .. �.f-+. .--.-..}•'•.: -• s:a.. a t r ..ter- .- . • • .
m�w+.ew .w.sn.nwn� ...;.,...,.na«.. _,. ,. ,...,,.,...�..�....v...,..'- '.'.w,r.....aT...,....,.,.,,,�.,,m.,..,...,....,...,..a•........,.,..�..,.,.T.,..,............:,..
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AREA DES ' ION EXIST PROPOSED TOTAL
SQ.F . SQ. FT. SQ.FT.
BASEMENT
FIRST
ki
•ECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑ COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL=STING Sr TOTAL PROPOSED Sr TOTAL sr
**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 fvctures 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(orTnb/shower Combo) LAVS(Bathroom Sulks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(rose
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBS SUMPS
' ;. SIGNATURE •
I certify under penalty ofperjury 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 /w� DATE
lgnature) (Title)
RELATIONSHIP TO PROJECT 0 Owner o Agent 0 Contractor ❑ Architect la-Other F Me- .P ct.l•.a k L.E.tt 5 U g-c o W me cn
a NEW o ADDITION o ALTERATION a REPAIR o TENANT IMPROVEMENT.
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? a YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? . o YES a NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
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Bulletin#100-January 1,2007 Page 2 of 4 k\Handouts\Permit Application .