07-104032 City OF 45"4...-... ,
Federal Way c ` �pFRMIT 7- - 1- � � � � �
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COMir1UNlTY DEVELOPMENT SERVICES
. MF CO ME EL PL DE EN ' •
33325 8M AVEN "SOUTH 0 PO BOX 9718
"6DERAL WW,WA 98063.9718 Nts % P L I C AT I O NT°
411-835-2607•FAX 253-835-2609 \ / /
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• The following is requil Onliit Incomplete application will not be accepted. Please print legibly(in ink)or type.
` • '• : IN •PROPERTY INF:RMATION '
SITE ADDRESS , L , .i " ,S ' M UITE IT# Al (-5 .
ASSESSOR'S TAX/PARCEL# 1 5 _00...__ _D _Oa Zt LO •SIZE (4)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page far lengthy legal desoipfion)
PROIECTINFORNIATIDN
TYPE OF.PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
•
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included
on this permit only) r
ac, Y'' �• S -R neLAD u 1L 1- C`J1 \if-izie,c.
Le_i
rd.A.r.v...:46_,L,
PROJECT NAME(Name of Business or Owner Last Name) .),..\,„ l r;-✓„�; F ;'7 2.61_, ,
. 11 PEOPLE INFDRMATION -x , ,
PROPERTYPRIMARY PHONE
OWNER ?I7Via-4)0\,SILLCATE11 .00. a...,
( ) -
1N D E-MAIL ADDRESS
• CONTRACTOR (O�PANY�NAME or . AP NTN,,Al' .. • \1-5Th)( al.
L� 0(F PH r%%
� lj� .II 40,::::6
-� � , ATE,ZIP (CELL PHONE
OF FEDERAL WAY BUSINESS LICENSE NUMBER. 0,
EXPIRATIO DATE FAX NUMBER
in D 030 -LS21S,
COPY of e�rd ngalrcd C TRA OR'S REQ RAI M ER EXPI 0 DATE • E-MAI ADDRESS •
,° e�eh:Pp1le�tlan \ / \-'4)(2161Cf
x 0 •
APPLICANT OMPAI�Y NAM \F/''/ APPLICANT NAMI/Ell ryTh OFF CE PI-AN
lip,
, ai.)01111 UCH
IP '
CeL WI-
Zt
Y/�Y/� 0�. \1e., c_11 6-.TO PRO ECT FAX NUMBER •
0 Architect ❑ Tenant 0 Agent 0 Other ( ) -
PROJECT NAMEr y PR E (� E-MAIL ADDRESS •
CONTACT In() C( O ( ( D
LENDER NAME �— ` Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
•,? • .III.-DETAILED BUILDING INFORMATION: .
EXISTING USE R):::`l IAA L 561-c PROPOSED USE RL-.5 1 411_ S f ii-C '
EXISTING ASSESSED/APPRAISED VALUE $ • VALUE OF PROPOSED WORK $ a ,-)D
,
elk:JD4I) SPRINKLERED BUILDING?
)(YES
0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? )(YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
AREA DESCRIPTIOEXISTING 0 PROPOSED TOTAL
SQ.FT. SQ. FT. SQ. FT.
,II .BASEMENT
1 FIRST' ' O \
•ECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT Cl
EXISTING PROPOSED TOTAL TOTAL FRISTINS SI TOTAL PROPOSED ST TITh:='
NUMBER OF FLOORS _
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $_
:.R FIXTURES.
Indicate number of each type offixture to be installed or relocated aspart 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 WOODSTOVEr.
BBQS FANS GAS WATER HEATERS bt MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS icommveiel) Y'x.(14, 5 f (rJK LC.'•A--'
COMPRESSORS • FURNACES RANGES
DUCTS. GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom Sinks) URINALS •MISC(Deacrioe,
110- DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS!roues
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 � - DATE 7-20-0
(Signature) (Title)
RELATIONSH TO PROJECT 0 Owner 0 Agent Contractor 0 Architect o Other
yy.
o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT.
BUILDING SHELL ONLY? D YES o NO BASIC PLAN? 0 YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES a NO
NEW ADDRESS REQUIRED? D YES a NO UP/SEPA/SU? . o YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
•
Bulletin#1GC,-January 1 200" Page 2 nr<, k\Iyanuouts\Permit Application