07-100330 RECEIVEQ
CITY OF 7 �
JAN 2 3 ) / - 10 0 330
Federal Way
PERMIT SF MF CO ME EL PL DE EN 9
COMMUNIWVY DEVELOPMENT SEBROvx Q^�f OF FEDERAL WAY
3332F FEDERAL
WAY,WA 806397 8BUILDINaAPPLICATION Tv
FEDERAL WAY, 98063-9718
253-835-2607•FAX 253-835-2609 / /
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY }/INFORMATION
SITE ADDRESS 3 Z ( ' s---- ?4(...f`P,'c-- I4 iS A ii0rt J SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - / e71I LOT SIZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for i'ogihy legal descriptikN
■ PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING. IRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of Mork included on this permit onll)
,/7
The t.( c",Vt c(0,-,...1 -,...c1 jf pi,i,?(Y6]f7hr, .ii✓,LtS, `Ci
PROJECT NAME(Name of Business or Owner Last Name) 0 17%..‘_4�t�- S'fo t
MI PEOPLE INFORMATION
PROPERTY NAME pi,
( PRIMARY PHONE
OWNER ES I llZ s'I ,-,5Q ( )MAILING ADESS CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAMEy APPLICANT NAME OFFICE PHONE
POl1< k f ( t ,s,.....,_ (lel )>4'/ -(c 16
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
16 - 5 .1~ckso„ `'f 3'ept(-FLe riM- (ipr-{ ( Lei ) '13 78-$;
CITY OF"FEDERAL WAY BUSINESS LICENSE NUMBER EXPIAATION
ATE FAX NUMBER
.Zt)—c,C -f N ( CI (3L i '.-�?I ' G ( 2-414 )
Z
. y iLiY1
CONTRACTOR'S REGI ON NUMBER IRA ONDATE E-MAIL ADDRESS
COPY of card required
with each application • /0 V f 'fIjJ 0 G0 t1c(� 1 !\vviL( Ue/I[A,...d
e•CO",
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
7 4'4 ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑ Tenant ❑Agent ❑ Other ( ) -
PROJECT NAME PRIMARY PHONE E-MAIL ADDXSS / '
CONTACT /-`jJ' r linty l/r,/ ( lc'c ) j?-7 - () 1( ro 2
k i✓l 57'V"Q/ •Caps
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
IN DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
S'-
3
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ ow,,—,
SPRINKLERED BUILDING? D YES C3�,NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ✓❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN n HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ 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(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS EXISTPNG
PROPOSED TOTALTOTAL EXISTING SF TOTAL PROPOSED SF 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
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 SE'T'S REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSE lb(Totten
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify under penalty of perjury 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 DATE /1j/4Lture) (Ve("Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent y Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
n NEW ❑ADDITION n ALTERATION n REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? o YES c NO
ZONING DESIGNATION CHANGE OF USE? ❑YES c NO
NEW ADDRESS REQUIRED? ❑YES ❑NO UP/SEPA/SU? ❑YES ❑NO
PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100-January 1,2007 Page 2 of 4 k\Handouts\Permit Application