08-105912 Federal
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COMMUNITY DEVELOPMENT SERVICES PERMIT SF MF CO ME EL PL DE EN FP
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3 ERAL�YF UTf13 01gEl 1 '4 200 APPLICATION
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The o. •tion-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS 2.2(it; S' 3). �� 57 41:4�!� SUITE/UNIT# 8/
7.
ASSESSOR'S TAX/PARCEL# - __ __ LOT SIZE(4)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) //,if Q /
(Attach separate page for lengthy legal descripdon)
•1 PROJECT INFORMATION
TYPE OF PERMIT 0 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)
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/�' E i , /-K--5ri i' S 7S�Fy�'L
PROJECT NAME(Name of Business or Owner Last Name) a 7/ a} o
• PEOPLE INFORMATION
PROPERTY NAME
PRIMARY PHONE
OWNER ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY APPLICANT NAME OFFICE PHONE /r�
I\ , r ayu� �w a.4 Lne-21 6/S -3 /3-
MAILING ADD I CITY, En ZIF CELL HONE
0 )3x &6� Tt,II (/)1` e. 14 1,b . (ofW� -3czp
CITY OF FED RAL B SIt{EnS‘LICENSE NNUMM:'R EXPIRATI T FAX NUMB R
, 0 �,/` t [2, altior (,M( ) .r-)V�3'CONTRACTOR'S REOISTRATIO NUMBERN DATE E-MAIL ADDRESS �t�r'
�`� KT�I o ; -,)-0/ o p-lf\fi - -f k-SNethtoo acs
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
'v'� 11i v C I ', W ( ), 1S J, Q)
MA.IMNG ADDRESSCELL?HONE
REI.1 ONSH P TO PR ,�. // �w 1 I LI IAA) I t%'F/ NUMHE c- y9
0 Architect 0 Tenant 0 Agent 0 Other (0?-114- 71--3V7 2'
PROJECT NAM PRIMARYPHONE / E-MAIL ADDRESS ,.
CONTACT rl Y�eS CL UJ (.i-2 `) 4 -3`� j ,, 3Ci L'U d l ' i"
LENDER NAME i
Per RCW 19.27.095:
Lender information is required if project value exceeds 55,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ l Ll. CINO
SPRINKLERED BUILDING? o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
1 1 •
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
EXISTING PROPOSED TOTAL. TOTAL EELSTfNO Sr TOTAL PROPOSED sr TOTAL Sr
NUMBER OF FLOORS
**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(Commerday
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(roikey
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 lication.
SIGNATURE: ‘/ DATEZ, —1)1c-'"C -
Property Owner and/or A prized Agent
a NEW a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? o YES a NO DEMO PERMIT REQUIRED? a YES o NO
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application