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Federal Way PERMIT
COMMUNTTYDEVELOPMENT SERVICES FEB 0: '• 2007 SF MF Co ME EL PL DE FP
33325AVENUE,WA 98 BOX 9718
APPLICATION
FEDERAL WAY,WA 9806363-9718 Allira /
253-835-2607•FAX 253-835-26061.r,yor (�EE�AL WAY,
wwwcituofiederalwaucom
i)
BUILDING DEPT.
The following is required information-an incomplete application will not be accep Please print legibly(in ink)or i
j • PROPERTY INFORMATION
SITE ADDRESS 3V1 3 y !J Ill A S /"� T SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# ( 6 5 0 ( - V ( 01-V LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal descnpttoC
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING XFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detnilnd description of work included on this permit onlu)
swShEEN Tirhgen PitomwcrS TE -'AT 101,KOVEeli G iv r Ft& - ALAv1'6,
srtS rE,-,
PROJECT NAME(Name of Business or Owner I fist Name) S H S.,116 N"' t'i rh d EA fka 0 w c rl
• PEOPLE( � INFORMATION
PROPERTY NAME (} 4i-- PRIMARY PHONE
OWNER 7 ( ) _
MAILING AD S C�,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Suwn'b ELEc1nor Ji(S Sal"' fL00441Qu1S1 ( LS1 ) int - 1..9 ES*
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
3y0C S 3'1 VI sr tAcomA, PJA 9S4O9 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
99 - 6633 Iz)311u1 ( ) -
COPY of card inquired CONTRACTORS REGISTRATION NUMBER E IRA ON DATE E-MAIL ADDRESS
with each applicationj t F fQ so 4 nc)a(e ctro a►es,Lo",
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
( )
MAILING ADDRESS COY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑ Tenant `Agent 0 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 COY,STATE,ZIP PHONE
( ) -
1♦ DETAILED BUILDING INFORMATION
EXISTING USE VACAr i PROPOSED USE OFF"(CE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ -2-
i Go •oo
SPRINKLERED BUILDING? )(YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
i
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
.84 2-0THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ID CARPORT ❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
gia
**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
Vnlue 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(or Tub/Shower Combo) LAVS(Bathroom Siulcs) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSh1b(toilet)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I cert 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.
r
NAME/TITLEPf10SEt-T olAivA(E✓' DATE 2f. 6 /O 7
Ifr(Ignat Mae)
RELATIONSHIP TO PROJECT ❑ Owner I `Agent 0 Contractor ❑Architect ❑ Other
FOR OFFICE USE ONLY
o NEW ❑ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? ❑YES o NO
Bulletin#100—January 1,2007 Page 2 of 4 k\Handouts\Permit Application