07-104465 C(FY OF y 4 (.2_
Federal Warr RECEty P F;R M I i 03:: MF CO ME EL PL DE EN 0
COMA/UNITY DEVELOPMENT SERVICES
733.3 87,4 AVENUE SOUTH•PO BOX 9718
1 a FEVERAL WA,V A 98063.9718 AUG 1 0 AP P L I.C AT I O T°
2k-835-2607•FAX 253835.2609 r-
mita cilNof(edernlwtm.coin t 1
CITY Or FGDE At.vi -- ! -.
Iddllilli
• The following is requirB(JlkiN taraaan ncomplete application will not be accepted. Please print legibly(in ink)or type.
. S PROPERTY INFORMATION rr
SITE ADDRESS !L ) Li. s` � JSUIT /UNIT# i a0
ASSESSOR'S TAX PARCEL# - tt
/ ...A._ � A) � ,� D _0�.�� LOT SIZE (sf)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
TROJECTINFDItMATION •
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT ES PTION (Provide detailed description of ork included on this permit onlu)
OW. Yea r s tiOalg
PROJECT NAME(Name of Business or Owner Last Name) /41,q G( Wi "
.,:v • • $ l • : V , •N
PROPERTY •NAME 1�Q �1 WW .
WA--LL. 0
A NG AD RES CITY,STAT ,ZIP E-MAIL ADDRESS
• CONTRACTOR OMPANY NAME APP IC''pp T NAME OFFICE PHO E
LI `A�cESS/1� `� rY 1 Y , lt. (Loi (i)
o ^�����}� ' F. CITY, ArE,'L1P '/�j' � �`'//�/���_ C LL.PIi9NE
OF FEDERAL WAY USINESS LICENS N MBER �EXP�jRATj01P DATE FA,X NUMBER
q i /Oi 58qT-Oc ( z -s 1 -0 . 4-3,s -LQ1-
copy of card regntredT�ORSEOISTR�TION NUMBER/► • - EXPIRATION DATE E-MAIL ADDRESS
with each application I y) \ ,' I °1
/ t
°) Di
APPLICANT OMPANY NAME AP ICA T NAM
v. T`^ (��/�\ (_p�`"\) !'�y�/� Lo/J OFFIC`)E�P�yH_/�►J E
LI hA 2E F C177;ST '„ �` C SC 7�HONE _
nONSHIPTO RO kie-• ���f • r/� I \Ain-
) FAX •
❑ Architect 0 Tenant 0 Agent 0 Other .0�y- )0M-(
PROJECT NAME
• PRIMARY PHONE E-MAIL ADDRESS
CONTACT ) \\/) ` ( t ( fitu ' (4 0
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 INFORI4IATION
EXISTING USE gA-I L S'ef4C 5 PROPOSED USE Ler i-[.� feAc o
EXISTING ASSESSED/APPRAISED VALUE $ _ VALUE OF PROPOSED WORK $_1Q l) O
SPRINKLERED BUILDING? " " ES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? r.S 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVENLAY_ 0 HIGHLINE4,
❑ TACOMA ❑ PRIVATE(WELL) \
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
AREA DESCRIPTI EXISTING PROPOSED TOTAL
SQ.FT: SQ. FT. SQ.FT.
;c"sMENT .
FIRST
3coCJ Via%
•ECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?) •
GARAGE 0 CARPORT 0 .
EXISTING PROPOSED TOTAL TOTAL EXISTING ST TOTAL PROPOSED ST TC'"A:,
NUMBER OF FLOORS _
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
. Indicate number of each type offxture 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)
i
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVLS
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS)commercial)
COMPRESSORS FURNACES RANGES
GAS LOG SETS REFRIG.SYSTEMS
DUCTS .
PLUMBING ,
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe;
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS troll.)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES ii
HOSE BIBBS SUMPS
. . 5 . 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 ---.-- 1-- �_ DATE v
ignature) (Title)
RELATIONSHIP TO P'OJECT 0 Owner 0 Agent r.!l-Contractor 0 Architect 0 Other
o NEW ❑ADDITION ❑ALTERATION o REPAIR ❑TENANT IMPROVEMENT. • •
.
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION • CHANGE OF USE? ❑YES o NO
NEW ADDRESS REQUIRED? o YES ❑NO . UP/SEPA/SU? . . ❑YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES ❑NO
111
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