08-100428 RECEPAD r
C.2 L - _LOD 4 a L
Federal way JAN 2 9 2008 PERMIT
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE EN�
333258'mAVEIVESOO.',•, FEDE�4�P��IYI CATION
FEDERAL WAY, 9 -8 5 6 / /
253-835-2607•F 8 5- 60
www.cihtoffederalwau.com CDS
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS a.00Q 5, J o rrl Si-. i--Qd ex-&1jW3 UITE/UNIT#
ASSESSOR'S TAX/PARCEL# - _ LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) i (CLQ t- I ryi, ,.,
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING (FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
LkI9qr".l Cit eV i�ti il. meg" CIlial- � 1 tt ' I f� &" Rescue
r tttirl'l Approved
As Detailed
Subject to attached detaila
PROJECT NAME(Name of Business or Owner Last Name) 1 U-Ce 1 1 MR—,
• PEOPLE INFORMATION
PROPERTY NAME :1 IP'
i PRIMARY HONE ---
OWNER ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
- 1 1-tood „orla ) c.A- i-r t sfie rt frit.- silex' (a (,) . - c iI
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
(PILO Om Ave . 6„ O.%,—WIN lb 10 ( ) -
4 CON CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRA IONN DATE FAX NUMBER t
1 -1i --REGISTRATION R 1 - G C) - ` ERpIRATION(- 0 ' E-MAIL ADDRESS tp c2Co(i
R'S
E
12TKOGDA-086Q L k--.)/ 1 /09
APPLICANT COMPANYNAMErAPPLICANT NAME OFFICE PHONE
GJ ,w o.' C r�� O,C1 r, , CITY.STATE,ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent o Other ( ) -
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT ( ) -
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 06C
s
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? X YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN o HIGHLINE 0 PRIVATE(SEPTIC)
•
Ill PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
sg.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 $
■ 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(orThb/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(collet)
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 arise • t 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 t •lication.
SIGNATURE: \v v 5-IAA _ DATE 12 - 0 Sr
Property Owner and/or Authorized Agent
FOR OFFICE USE ONLY
D NEW o ADDITION D ALTERATION o REPAIR n TENANT IMPROVEMENT
BUILDING SHELL ONLY? n YES r NO BASIC PLAN? n YES n NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? n YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES D NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100—August 16,2007 Page 2 of 4 k\Handouts\Permit Application