08-103151 //y
QTY IIIII
OF4141‘ O — 0
Federal F EIVED PERMIT SF MF CO ME EL PL DE ENO
l — — l 6 (
— —
COMMUNITY DEVELOPMENT SERVICES
33325 8TM AVENUE SOUIN•PO BOX 9718 p.p L I C ATI O N
FEDERAL WAY WA 98063 9718m / /
253 835 2607 FAX 253 835-26Q�UL O 1 2a
v
The fol it g seii f'f'i,►t¢>�gntt iiki omplete application will not be accepted. Please print legibly(in ink)or type.
e�L ltfl L M /nPRO,PROPERTY INFORMATION
3.31-4314 SITE ADDRES3.31-4314 - 2+-h AVE 3 SUITE/UNIT# I l/J
ASSESSOR'S TAX/PARCEL# (7 0 9 y 3 0 00 1 0 LOT SIZE(sfi
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) f CU dx I C)(1 5t-o-I-e P.r 114
(Atmch separate for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT O 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)
Sit
+-h Fire S y s fems tgi It extend *fie. et 1 slinQ V&pipe 3 r n,eler
R. OJSEC-tem . (Name pro-hoc-I-Busyie/QQ ta�mMe Ce i/in S ° rS‹uo
rer dss
V5eS r .. --„,,,./''',,„,,,'- � s"-Li rmx/
(:cl r / fa' i` au�� /cQr2ltheayMar✓ hr�
c.
i,U eisT N e Cu i�fp
inss or Owner tNe) 71rGi d.-GN e..-1 So n s' }" om crMI
• PEOPLE INFORMATION
PROPERTY PRIMARY PHONE
OWNERNAME U tS fa1- verTe- vicesWJ
ING15 j A0131014 E-MAIL ADDRESS
/015- ft iota
,w
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
, YYll�n �re. sferi'1sInCt �Lbhn �h�rrol (a5 )cgg8 -x(959
1`SING ADDRF-Sich t CITY,STATE.ZIP �8 CELL PHONE -
CI7Y OF FEDERAL WAY BUSINESS LICENSE NUMBER C�ATION ATE FAX NUMBER
tri'- 7-OW°554)0 - 6L 12/31 fog (a53 ) (1a0 - -a350
CONTRACTOR'S REGISTRATION NUMBEREXPIRATION DATE E-MAIL ADDRESS
Smk.41 '1\ )(o0`Tr if/2/08 it ther6 rd@Sm hfie(OK
APPLICANT C MPANY A{NE / r}p Q/y� I APPLICANT AM,� / , ` OFFICE PHONE/ '
MAILI ADDRESS
C€ til f1lISI 111C. CITY,
tP ei rci (c953CELL )a/-48 -c .65
E
1\O — 5144) NEE ma(toA gLia>k ( ) -
RELATIONSHIP TO PROJECT }� FAX NUMBER
0 Architect 0 Tenant ❑Agent Other U e-s t gfke C (as.-33 )cl a(p -0350
PROJECT N E y� in PRIMARY PHONE nn E-MAIL ADD S [art
CONTACT Thr\ \ r rd (�53)a�I ' cL usl 1• "•'e C�7 oe.(oM
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USEt
roryMer Cif/C
EXISTING ASSESSED/APPRAISED VALUE$ r VALUE OF PROPOSED WORK $ - , 5(o
SPRINKLERED BUILDING? DYES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? [IES o NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
• PROJECT FLOOR AREAS
DESCRIPTION
DECK(❑COVERED OR 0 UNCOVERED?)
EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ. FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)AREA
GARAGE 0 CARPORT ID
NUMBER OF FLOORS EXISTINGPROPOSED
TOTAL Fusrma SF TOTAL PROPOSED SF TOTAL.SF
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
• FIXTURES
Indicate number of each type offbcture 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(Comme ciaq
COMPRESSORS FURNACES RANGES
DU( IJ GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(orThb/Shower combo)
DISHWASHERS
LAVS(Bachmomsnks) URINALS MISC(Describe)
RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSN lb C oueq
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 application. //��
SIGNATURE: C.. (9/ s,I DATE <Q OC1
ittt
Property Owner and/or Authorized Agent
FOR OFFXC.E USE ;NLY
o NEW o ADDITION a ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN?
a YES ❑NO
ZONING DESIGNATION CHANGE OF USE? a YES ❑NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES ❑NO
PLATTED LOT? ❑YES o NO
Page 2 of 4
DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100-January 1,2008 k\I-iandouts\Permit Application
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