08-100095 RECR\14111 •
JAN 0 7A04I O - Q�
Federal Way PERMIT
COMMUNITY DEVELOPMEN v aF FEDERAL WAY' SF MF CO ME EL PL DE EN P
333258TEAVENUESOUWAY,WAI'H•98083-9POBO71>��p�pING DEPAPPLI CATION
FEDRAL
253-835-2607•FAX 253-835-2609
www.cityoffederalway.com Agui usdp
The following is required information-art incomplete application will not be accepted. • -ase print legibly(in ink)or type.
■ PROPERTY INFORMATION
SITE ADDRESS_ ,33' 3 y e/G 147w .4✓4- Sova SUITE/UNIT# ?-
ASSESSOR'S
ASSESSOR'S TAX/PARCEL# 9 z 6 O / - 0 / 2 O LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING a(FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detnilpd description of work included on this permit only)
AD!) F'EN)cvr Tyre sea/Ai/ad-it AC Corot lobA7z" ti,,/ A/•oc2S 9` ems"/L/A//
PROJECT NAME(Name of Business or Owner Last Name) 630-p7--- /VC £vim
NI PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER EG/5 /eC4C E$T'A'T2r" S6/LV/G AS ( ) -
MAILING ADDRESS CITY.STATE,ZIP E-MAIL ADDRESS
aw at14/41L5/7 SI .175"
Se46' (AM f@/o/
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
maize' Sr5rziel5 z-Vterr e e4/4 til/,c 1Z. (Zs-2) gj3 - .Zyr?
MAILING ADDRESS CITY.STATE,ZIP CELL PHONE
,q ' 647-44 f//.�(/ #/3 ."Ac/F/c, /4i4 9x30517 ( 3 ) 2O2 - 70 y
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
/9-8- 0000/4y-co-Lit_ (Zr3 ) 735- - vi/3
COPY of card requi CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
red with each application /5'O Q/ C-Zr414MCFiersnna,swow"-Cws,,
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
.cid s rsrcyiS 11./'G"Sr — ( ) -
MAILING ADDRESS CITY,STATE.ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect ❑Tenant in-Agent 0 Other ( ) -
PROJECT NAME/ PRIMARY PHONE E-MAIL ADDRESS
C
CONTACT C44/6 , i/LGC/Z (esS) 633 -/2y9 CxA/4aH�
Ffa4srsTL etcAt/d'sr.Cedt
LENDER NAME Per RCW 19.27.095:
Lender information is required(f project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE S 4J' ZL - PROPOSED USE c%7•4502G/'
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 2 Z o 0
SPRINKLERED BUILDING? et'YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? DYES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN o HIGHLINE ❑ PRIVATE(SEPTIC)
u.
17a,RS
•
• AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ. FT.
BASEMENT
FIRST
•
SECOND •
THIRD •
ADDITIONAL FLOORS(DESCRIBE)
•
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0 •
•
NUMBER OF FLOORS tl10 Piososss TOTAL roux,ssanM7sr TOTAL PROPOSED el TOTALS?
•
•
'!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(comsuaiiq
COMPRESSORS • FURNACES RANGES •
DUCTS. • OAS LOG SETS REFRIG.SYSTEMS
PLUMBING •
BATHTUBS(er7leb/shoraresmbo( LAVS(D.throomsfnt.( URINALS MISC(Describe)
• DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS tros.q •
ELECTRIC WATER HEATERS SINKS WASHING MACHINES .
HOSE BIBBS SUMPS • •
• SIGNATURE •
knowle tlunder penalty of perjury that I am the property owner or authorised agent of the property owner.I cert(y that to the best of ma
dg. Wormation submitted in support q f this permit application is true and correct.I certlf that I will comply with all applicable
City of Federal Way regulations pertaining to the work authorised 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 onil
where such claim arises out of the reliance of the city, including its officers and employees,upon the accuracy of thein formation supplied to
. the city as apart of this application. —
SIGNATURE: .%✓/ • DATE / 7-08
Property Owner or Authorized Agent
•
c1.•�13J' 1t �t;aCe'<
a NEW a ADDITION • a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? • a YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
•
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—January 1,2008 Page 2 of 4 k\iandouts\Permit Application