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Federal WayPERMIT
COMMUNITY DEVELOPMENTSERVICEAPR 1 6 2007 SF MF CO ME EL PL DE EN P
333258T"AVENUE SOUTH.PDBOX 97'8 Epi �/j�� PLICATION
53D835 2607 FAXWA 25383597910.91 y oit F`,„,,,/11..�ITf9%� m .----7—
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www.cLWottederalway.com BUILDING DEPT.
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
111 PROPERTY INFORMATION
SITE ADDRESS 75/207 p to C,r'C I S � k - SUITE/UNIT# 4/0 l
/.
ASSESSOR'S TAX/PARCEL# %'/.'' j/:::/�« - —— LOT SIZE(4)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot I)
Attach separate page for lengthy legal description)
U PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING XFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
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PROJECT NAME(Name of Business or Owner Lost Name) f3AP'P / 7fS ,, i)
U PEOPLE INFORMATION
PROPERTY NAMEr PRIMARY PHONE
OWNER j (J S Al V./ ( )
MAILING ADD CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
f
Ca t I t t%tl'e a_ :: ( )
MAILING ADDRISS �,, CITY,STATE,ZIP CELL PHONE
�'Z- t 091,/,‘,-- ' .c� S ate.,4e// Cia q gl V.`/' (.10, ) 3 5 5 - -7 1 c V
COY OF FEDERAL WAY BUSINESS LICENSE NUMBERD•WIRATION DATE FAX NUMBER
. )Ci —01 REGISTRATION 5-04-71..k
_17 t- l C ei C; ( )
CONTRACIUR'S REG ON EXP TION ATE E-MAIL ADDRESS
COPY of card requiredapplication
with each applieatran t�C�C rs( ac/30/t)-7
APPLICANT COMPANY NAME �� ` APPLICANT NAME OFFICE PHONE
2)C. Flee-qv—'?'IPI ' 7/ �P ( )
I AD P' ICA �?/, -- f16-t avz IP �t bi/r FAX NUMBER ss -7 1
DONSIP TO PR ECT
o Architect 0 Tenant )(Agent ❑ 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 $
SPRINKLERED BUILDING? YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ 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' ❑
EXISTING PROPOSED • AL TOTAL RE/STING 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 i, BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE'*OOLERS AS PIPE OUTLETS WOODSTOVES
BBQS FANS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSE HOODS(commcrctal)
COMPRESSORS FURNACES RANGES
DUCTS GAS LO SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or7Lb/Shower combo) LAYS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Tenet
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 et r%t i1t- DATE I /G' 'C '
(SIgnatur (TI e)
RELATIONSHIP TO PROJECT Owner ❑ ent 0 Contractor ❑Architect 0 Other
FOR OFFICE USE ONLY
n NEW n ADDITION ❑ALTERATION ❑REPAIR n TENANT IMPROVEMENT
BUILDING SHELL ONLY? n YES ❑NO BASIC PLAN? o YES c NO
ZONING DESIGNATION CHANGE OF USE? ❑YES o NO
NEW ADDRESS REQUIRED? ❑YES n NO UP/SEPA/SU? ❑YES o NO
PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? ❑YES n NO
Bulletin#100—April 2,2007 Page 2 of 4 k'Handouts\Permit Application