08-103441 A0/40.
CITY OF ' 1 J 3 'b q
Federal way PERMIT
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME �:-5:•••••••-5:••••••• DE EN
333258NAVENUE • 9718 APPLICATION
FEDERAL WAY,.W 9 9806363-971971 8 / /
253-835-2607•FAX
253-835-2609
www.ctlyoffederalway.com
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
PROPERTY INFORMATION
SIT 0 ae.. t-. J_h 'C✓ai S SUITE/UNIT# L Y
ASSPSOR3S TAX/PARCEL# LOT SIZE(sj)
LEGAL DESTIPTIQI$(a.g. me Estates,Lot 1)
�!�Ilea (Attach sepro.ate page for lengthy legal description)
in PROJECT INFORMATION
TYPE OF PERMIT COS ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING V FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
LC-NA) ief •A A)e F-57-pg A- ../N 2 vvy -re-1.)A N r Tin p c:ax wl E►�l
PROJECT NAME(Name of Business or Owner Last Name)'3'r2 ` Rids — S1 Fa�
PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER t3 11>j iJ-et-sC. -TATE: 7-AC CZE ( ) -
MAILING AD F y.' '"' CITY,STATE,ZIP E-MAIL ADDRESS
•
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
F'Q� S T MS cS Foto CO Pe Tfl SWT- (2s3 ) 843 - 2-`43
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
21ei FRO1/4;rpt6E RD 1). !}18 12ANFir- . 1.)4 . ci$047 (LS3 ) 202 - o`ac7
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
St.„)y GSSL.0 Ibto1
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
_ ( )
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 FflANC.® 2S7 ) 2.02. -
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 $ 1 I) •CO
SPRINKLERED BUILDING? AYES El NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN o HIGHLINE 0 TACOMA El PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
sg.FT. sg.FT. SQ.FT.
BASEMENT
FIRST ——
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT 0
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SP TOTAL PROPOSED SF TOTAL SF
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
MI 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)commerewa)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS)orThb/shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS ribi)et)
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 ap. ' •ti•
SIGNATURE: DATE —7 5
7'
Property Owner and/or Authorized Agent
I FOR OFFICE USE ONLY
o NEW ❑ADDITION ALTERATION REPAIR TENANT IMPROVEMENT
BUILDING SHELL ONLY? YES NO BASIC PLAN? n YES r-i NO
ZONING DESIGNATION CHANGE OF USE? o YES ❑NO
NEW ADDRESS REQUIRED? c YES u NO UP/SEPA/SU? o YES NO
PLATTED LOT? u YES u NO DEMO PERMIT REQUIRED? YES n NO
Bulletin#100—August 16,2007 Page 2 of 4 k\Handouts\Permit Application