07-100510 CITY OF. _S
Federal Way - U )
• PERMIT - �� �SF MF CO ME EL PL DE EN
COMMUNITY DEVELOPMENT SERVICES 0
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3332S8T"AVENUE SOUTH•PO BOX 9718 P L I CATION
FEDERAL WAY,WA 98063-9718 TD
.253-835-2607•FAX 253-835-2609q>
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The following is required information-an incomplete application will not be accepted. Please print legiblyk ink)or type.
S PROPERTY INFORMATION
SITE ADDRESS 2�cne2 —S c, /l s J SUITE/UNIT# C MC
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sf) 71::. 1\.k •
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 1NFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlq)
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)/15 -ci . U.L ac }ire_ l�P,9' {'JJ;'Y? y Jew.., -
PROJECT NAME(Name of Business or Owner Last Name) £h o DG4.1/ �d
U PEOPLE INFORMATION . •
PROPERTY NAME
- - PRIMARY PHONE
OWNER
.2200 . s 3' Gj�1''t-t °oL' • ( )
MAILING ADDRESS CITY,STATE,ZIP
E-MAIL ADDRESS
CONTRACTOR COMPANY NAME II APPLICANT NAME OFFICE PHONE
r , Alt or S TE,Z (ELL ) �3 95?2-
MAILIN c i. f / ) / CITY, TE,Z
5—/Sy S LU r/e_S ! \ #e /� 9•„)-#,61--
• { CELL )..q L(�
n Y C TIO 7 . 7(r (e; )s(,, l j
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPI TION DATE
FAX NUMBER
( ) -
COPY or card required CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE
with each application I E-MAIL ADDRESS
APPLICANT COMPANY NAME APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS CITY,STATE,ZIP ( )
CELL PHONE
RELATIONSHIP TO PROJECT ( ) -
0 Architect 0 Tenant ❑Agent ❑ Other FAX NUMBER
( ) -
PROJECT I NAME
lPRIMARY PHONE
CONTACT I E-MAIL ADDRESS
( )
LENDER NAME Per RCW 19,27.095: .
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
PHONE
( )
' "` • IN -DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
:4 1 - l o£.! ,.1, ,- -:PR•al • • 'rI
AREA DESCRI )N
EXISTIN 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
EXISTING PROPOSED TOTAL TOTAL EXISTING Sr TOTAL PROPOSED Sr TOTAL Sr
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
a 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(commercial)
COMPRESSORS FURNACES RANGES
GAS LOG SETS REFRIG. SYSTEMS
Dugs, %
PLUMBING
BATT-(TUBS(or Tub/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS ' RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS _ SHOWERS WATER CLOSETS{miler)
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.
1
NAME/TITLE DATE
(SI aturt) (Title)
RELATIONSHIP TO PROJECT D Owner *Agent o Contractor ❑ Architect ❑ Other
te'®; F �43,t6* t 1
o NEW o ADDITION o ALTERATION o REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES o 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 ❑NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
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Bulletin#100—January 1,2007 Page 2 of 4 k\Handouts\Permit Application