08-100289I
OF RECEI\\I R_ / _ Q d c2: •
Federal Way -
SAN 18 2008 PERMIT SF MF CO MI r.L, DE E 0COMMUNITY DEVELOPMENT SERVICE.
3332E Eat AVENUE SOATH•PO 9 9 718
,FEDERAL WAY.WA 98063-97)8
253w$t3Fw64o•I m FEDERpp ,ICATION
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The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
/ G �` 2 MI PROPERTY INFORMATION
SITE ADDRESS_ n a'1 3. 32 U' cST. /"CnG L Am/ 9.�'a93 SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING El PLUMBING ❑ MECHANICAL
0 DEMOLITION ,LECTRICAL ❑ ENGINEERING X FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work,.....ceded on this permit only)
ht)ht)S rite-4._ ,v6 40 ,a-//Le .SYS TEri co.aciJ.ri.✓a'- 0/= /,!',rioter ,.2 4c,c LGS,
Voar _Sir/o,tcs .✓o. 4vQ,6isiy/S"72ocr a
PROJECT NAME(Name of Business or Owner Last Name) 0...S (-3 ,s/1 DES
• PEOPLE INFORMATION
OWNER
PROPERTY NAME�€zT - \ I` V i _. ` Q PRIMARY HONE -
MAILING ADDRESS eV'/ 1V Q/`CITI1Y,STATE,ZIP - E-MAIL ADDRESS
DRESS
CONTRACTOR CON i NAME .APTLICANT NAME OFFICE PHONE
4N1--4-4/41 7 C/-/ /,1'c
I n�Cl,�g by ( yz,� ».s 4 c '
v ADDRESS CITY,STATE,ZIP CELL PHONE
0- &X /&c /V -r Gt)/-( 98OY3 (`as ) (f.3/ - 2a2G
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
[- (�_ /q C` ( ( W ) 72 -SY)o
CON��TRACTOR'S REGISTRATION NUMBEREXPIRATION
DATE E-MAIL ADDRESS Ric He
yy
)7 C t'c f;?r 1(.0"//V-k U -/9-ca Act-bokiTECH/NG eve47-h3 cc-44A_
APPLICANT COMPANY NAME 11CANT NAME OFFICE PHONE
41e-4,Zr/,r'eNV JA/c. l icr/ reeng07/ vas—) 72S-- Y.206'
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
P.&.30y/e(P AvA/r C reddA ;40 9e ( '2J1 93/ - 70 to tc
RELATIONSHIP TO PROJECT ' FAX NUMBER
❑ Architect ❑Tenant ❑Agent "'Other S v6-a'o.r1�24C rd& (ws-1 77s--- -s-Wo
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT ( ) -
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
U DETAILED BUILDING INFORMATION
EXISTING USE o!)7j >, S'nc 6 PROPOSED USE -.2E?19/L
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ / WO
SPRINKLERED BUILDING? pcYES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER a LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. Sg.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT' ❑
NUMBER OF FLOORS EXISTING PROPOSED Tam, Dorm.EXISTING SF TOTAL PROPOSED Sr TOTAL SF
"NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Val iP 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 SE lb REFRIG.SYSTEMS
PLUMBING
BATHTUBS(orThb/Shower Combo) LAYS(Bathroom sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Tones
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 o
SIGNATURE: .4167 <at�le DATE ��O 'Oa"
Prope Owner and/or Autho .Agent
FOR OFFICE USE ONLY
n NEW n ADDITION n ALTERATION n REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? n YES c NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES n NO
NEW ADDRESS REQUIRED? n YES n NO UP/SEPA/SU? o YES o NO
PLATTED LOT? n YES n NO DEMO PERMIT REQUIRED? o YES n NO
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application