09-100486 RECE
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Federal Way dill - ���
COMMUNITY DEVELOPMENT SERVICES FE-8 SF MF CO ME EL PL DEE FP-
33325 8",AVENUE SOUTH•PO BOX 9718 �" V.5 �
FEDERAL WAY,WA 98063-9718
APP L I C A T I O N TD / /
253-83 AL WAY,
FAX 253-835-2609 - r�
uvua•.citrtoffederalwau.com �I'•• fr-p t,_
The following is required infgrnj4ion-an incomplete application will not be accepted. Please print legibly(in ink)or type.
��''aa�� IN PROPERTY INFORD •TION
SITE ADDRESS_ ?a` 3 3 Pk x4 LA• SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# CJ Lt -2-- / Ci - C/ C., 'L( 1#U
— LOT SIZE(s])
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) Liiir. DCtLi,I
(Attach separate page for lengthy legal desoipaor) t"?e,,4,;_, CI
IN PROJECT INFORMATION
TYPE OF PERMIT .,
❑BUILDING 0 PLUMBING 0 MECHANICAL ------
_
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING FIRE 13iFCEVENT�ON SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
C21✓L+VU ( 474 vt4.( -f- -- 4.— cL )Lc4.,U
PROJECT NAME(Name of Business or Owner Last Name) -fox €3 4 e i,vt 1
• PEOPLE INFORMATION
PROPERTY NAME / PRIMARY PHONE
OWNER kq►,�-ill, a c vi P�fD `t' LL. C.- (14z5) zcif -`5Z64
MAILING ADDRESS CITY, ATE,ZIP E-MAIL ADDRESS
'33 ,5 Q ? - G1 ` ` /fife_ S, t"-,1: t.( (,1 ' j_
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
l v-.t '1- �►,n,C110,'I. s r�k L.'i e i k-Fe,I.-(—, ( ) Z 5 a -4 7(9
�D*D CITY,STATE, P -
� .�"j 3 CELL PHONE
q �--, gyo/3 (z�3) L -177
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER OTE FAX NUMBER
4
f Op 449 Io 127,71(z
cwt (30) .s ..?`":1Y°
CONTRACTOR'S REGISTRATION NUMBER TIC E-MAIL ADDRESS(Q � !� ..,41-`s.'‘, ;'‘�Qts,,
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
5411a- A-5 i -io q--L_. ( ) _
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant ❑Agent Other (t kvt.,W a ( ) -
PROJECT NAME.- _
CONTACT `, (Z �[. PRIMARY PHONE E-MAIL ADDRESS
it(t r LC 1--.. ('Z. 26Y-- 7 1.9
LENDER NAME Per ROW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
/r DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ l Z7 C,) U 0 e OO
SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 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
NUMBER OF FLOORS axisrneo PROPOSED TOTAL TOTAL 3ffi77Na Sr TOTAL PROPOS.=Sr TOTAL Sr
"NEW HOMES ONLY** NUMBER OF BEDROOMS _ ESTIMATED SELLING PRICE $
E 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
PLUDOTING
BATHTUBS(or Tun/Shower Combo) _ LAVS(Bathroom Skim) URINALS MISC(Describe)
DISHWASHERS _ RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS _ SHOWERS WATER CLOSETS(ca.)
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: DATE 2-
Property Owner and/or Authorized Agent
r . .Tri- :. - f
1'yJ J1� � �
a NEW a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? o YES a NO
ZONING DESIGNATION CHANGE OF USE?
a YES ❑NO
REQ o YES . . .o NO ......_..
NEW ADDRESS REQUIRED? ❑YES ❑NO IIP/SEPA/SU?
PLATTED LOT? ❑YES a NO DEMO PERMIT REQUIRED? a YES a NO
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Bulletin#100—January 1,2009 Page 2 of 4 k\Handouts\Permit Application