08-100126 REC ED •
cln of
JAN 0 9 06/ " - ( DO ( 7
Federal Way — —
COMMUNITY DEVEWPMENTSEa�ic�TY OF FEDERAL W SF MF CO ME EL PL DE EN
333258,"AVENUE SOUTH•PO BOX snI$UILDING DX
FEDERAL WAY,WA 98063-9718 TD
253-35-2607•FAX 253-835-2609 P LI CATI O N
www.cituoffederalwau.com ---
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
i PROPERTY INFORMATION
SITE ADDRESS 33 y/3 y L/GNT/ 41/‘ �v� SUITE/UNIT# /D z
ASSESSOR'S TAX/PARCEL# k7 ,��/ - D 0 0 Z r) LOT SIZE(4)r
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) 6,F �/V S U 4< L
(Attach separate page_for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING ❑ MECHANICAL
0 DEMOLITION 0 ELECTRICAL ❑ ENGINEERING(*FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
ADI) / 'iZ Vb -,lir TY/'- _coo//A//'Lce-"Z IT, AG,con-e.,11 oADA re:- i-at, a/�oc.Ks 9' cC`/L,41l4%
PROJECT NAME(Name of Business or Owner Last Name) L70 /14/564eI 47 ((
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER EG/5 /eC46 tSrA7 Sc#Zv/Cd-s ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
6 t) dv/t/ans/Ty- s' /s/s-
seil TTZd' w4 f /o/
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
.�/le. srSrzj.^s 41/4 3"7" G"* ". /4 til/t`cL,n (2sa) X13 - ,ZyB
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
2/q G46/L7446- /V..1/ #3 /`74e/Fic, &VA 93OY7 (zS-3 ) eat -070Y3
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
/9-8%7- 0000/V-oo-,e3 L ( Z "'3 l - Occ' (Lrj ) 735- - c2//3
COPY of card required CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
with each application C/ 'S 4a/ /yO 43/ Q2 ,-i Z-0 Cl C .474 MC fat a"SYSTA>e7s fel 0',7":Carrs
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
.cid s ysrcir7S `✓G''S7 — ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect o Tenant ..'Agent 0 Other ( ) --- -
PROJECT NAME PRIMARY PHONE E-MAILS �i�S
CONTACT C/?4/1 /,- /Z.W1 (2s ) 933 -/2 Ye
A.,2e"r 5.71-'11q/•rST.Cowl
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE SfeeL L PROPOSED USE d.Ci,2G!l
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 2 2 0 0
SPRINKLERED BUILDING? 'YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? BYES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN o HIGHLINE 0 PRIVATE(SEPTIC)
• 4111
• 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 EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
II 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(commerelaO
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG S1.IS REFRIG.SYSTEMS
PLUMBING -
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toilet)
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 S .� =� DATE ` ?- C
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner 0 Agent ❑ Contractor 0 Architect ❑ Other
gviCE"USE;LZNLY:
o NEW o ADDITION ❑ALTERATION ❑REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100—April 2,2007 Page 2 of 4 kU-Iandouts\Permit Application