07-105182 R�t�E�V� � _s_ k C1 Z
�'���r��I�lVay PERMIT
COMM DR VELOPMRNT SER VICES SF MF CO ME EL PL DE EN P
3332FEDE5 8T"AVENUS SOWA 9UTH•PO BOX]8 971 d:E P 17 APPLICATION
RAL WAY, 8°P°6
63-29';'
9 7
TD / /
253.835.2607•FAX 253-835.2609
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')ERAL WA
The following is required infornidt t-r-an incomplete application will not be accepted. Please print legibly(in ink)or type.
■ PROPERTY INFORMATION
SITE ADDRESS .-...i 3 a(-- ()`- c i.. SOU RAA.,. SOU + _s-‘.>,
'C 2-o 3 SUITE/UNIT# U L 'S
ASSESSOR'S TAX/PARCEL# ( =c 2V �/v- 6 O_2- LOT SIZE(s,f)
^
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) v O' 'Q ��9 K LI L . leO V c'4�. 17 e d . yr-3f- t1.4 t 1L
(Attach separate page fort description)
111 PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING. 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING AFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
PROJECT NAME(Name of Business or Owner Last Name) t} tti Se INCt tti y KO U.( g-0 Yt`_ttLt I3K4.rr5 Atie t,-(-
II PEOPLE INFORI'JATIONN
PROPERTY NAME jr,_ � PRIMARY PHONE
OWNER 4 -e. j1 in tlt t/l i d'1/rr'C s.& t'�Q • Yes ��tdTJ ( ' ) -
MAILING ADDRESS c7 K CITY,STATE,ZIP E-MAIL ADDRESS
33 3 2- Pct -i.�(c i.i
`I e 147 .�
CONTRACTOR COMPANY NAME A APPLICANT NAME . OFFICE PHONEN7
0)(MAILIADDRESS F e ( rD J cc�t l R� `STATE e( 0(4 e�GC (E L'6 ) 2 -? 'f&
CI OFY WAY BUSINESS CENSE NUMBER � XPIRATION DATE 044 f r V FAX NUMBER
`A -�f
„`� �� I OL'l f$ f3cj -ori Z � -O 7
CONTRACTOR'S REGISTRATION NUMBER. EXPIRATION DATE E-MAIL ADDRESS
►2T G Q �.�7 P o 'Iv&jZOO 8
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
MAILING ADDRESS �� CITY,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent 0 Other ( ) -
PROJECT NAME c /_ / PRIMARY PHONE E-MAIL ADDRESS
CONTACT ( G/n N_O`(� T-6,-- ( ) -
NAME
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS _S45----- CITY,STATE,ZIP PHONE
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE ,>
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ DC7 S2 0 ,..,0-c
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?,YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER o LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESC• e N 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 EASTIRO PROPOSED TOTAL TOTAL EV817NO SF TOTAL PROPOSED Er TOTAL Sr
"NEW HOMES ONLY" NUMBER OF BED•o OMS 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 INSERT% HOODS(Commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS)or Tub/Shower Combo) LAVS(Bathroom sink.) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS crone)
ELECTRIC WATER HEATERS SINKS WASHING MA7S
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: ( O($- O V l �_,� a DATE 0 GI
7/n 7
Property Owner and/or Authorized Agent
o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES a NO DEMO PERMIT REQUIRED? o YES a NO
,
Bulletin#100-August 16,2007 Page 2 of 4 k\Handouts\Permit Application