08-100762 •
RECEID / ^ /�/
CITY OF D 1 0 D 1 ' U �/
Federal Way FEB 15 2008 PERMIT ��LL �C .fL\
COMMUNITY DEVELOPMENTSERVICES
SF MF CO ME EL PL DE EN
33325 8TM AVENUE SOUTH•PO BOX 9718 � ��-/
A
'1538352607FEDERLWAY,•FAX�W098 OF FED FEDEI&P CATI ON
www,cituoffederalwau.com
CDS
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
a� PROPERTY INFORMATION
SITE ADDRESS_ 1-)1 y 3 v+h AVE 500714- SUITE/UNIT# I C) 2
ASSESSOR'S TAX/PARCEL# 6 v ' ,? 0 - D 0 O LOT SIZE(sf1
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page far lengthy legal desoiptian)
■ PROJECT INFORMATION
TYPE OF PERMIT ❑BUILDING LI PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING (FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
1 iac!_ .rte• — IjLt Ds AW\ l
PROJECT NAME(Name of Business or Owner Last Name) 6 O F t— L)S tJ (E
PEOPLE INFORMATION
PROPERTY NAMEPRIMARY PHONE
OWNER 16 fn C1 f L-L C.. ( ) -
MAILING ADDRESS CITY.STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
P12€c%sloj At-An/PA r✓LrIJLc PETflP s►=r ( 2-1•3 ) - (i v 3
MAILING ADDRESS CITY.STATE,ZIP CELL PHONE
211 �=r1�71J r�6l (16 j- it t3 C'At_t r I` , w (?S"3) 202- - 7is t-ro
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
2 A 00'-I - 217> 1 o8 (zr- ) ?3i- 01,3
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
PREC1A L O;i II- a.7-o8
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
PCWCA StOrJ A u‘k 1 ‘ki' w. ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant ❑Agent ❑ Other ( ) -
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT r--OPc1J( (2-53 ) g2, - \2t-tFKlrSYS; niuAr&i.L
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 $ 2.1q1 •9595
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
+ • •
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
sg.FT. SQ.FT. Sg.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
EXISTING PROPOSED TOTAL TOTAL EXISTING 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 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 IComnurctaq
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or mm/shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSLlb rronru
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 applicatio
SIGNATURE: DATE 2-l \ q t3
Property Owner and/or Authorized Agent
FOR OFFICE USE ONLY
D NEW o ADDITION D ALTERATION c REPAIR 3 TENANT IMPROVEMENT
BUILDING SHELL ONLY? n YES n NO BASIC PLAN? n YES n NO
ZONING DESIGNATION CHANGE OF USE? D YES D NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? n YES n NO
PLATTED LOT? o YES a NO DEMO PERMIT REQUIRED? o YES D NO
Bulletin#100—August 16,2007 Page 2 of 4 k\Handouts\Permit Application