07-106668 RECEIVED
tit
t, = DEC 1i 07 410
` CITY OF 'q'" "`s'- "' i 0 S� 3. L •.
Federal CITY OF FEDtFIAL�n► yERMIT ��f"
BUILDING DEPT. SF MF CO ME EL PL DE EN"FP
COMMUNITY DEVELOPMENT SERV/CES
333258'ERAL WAY,WA7N•P06oX 9718 APPLICATION
FEDERAL WAY,WA 98063-9718 ID /
253-835-2607•FAX 253.835-2609
www.r-ityutfederalwnu.cure
The following is required information-an incomplete application will not be accepte Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS 115 03 'oI 4,-. cocA SUITE/UNIT# 300
ASSESSOR'S TAX/PARCEL# _ 501S1 - 00 5 ( LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page far Lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING /FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onig)
-F2 F-c—ocaTC S'P I)i)(L_ Z HEFt17-S /- 1 /vee,-/
,.-4,1LLS ir4 CJuti DR61 IS ,os?ITei. ,fit i4LF-
PROJECT NAME(Name of Business or Owner Last Name _ •
... — Il 0
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER C11(5 as (. 1 -) , --7,5-04]
MAILING ADDRESS I CITY,STATE,ZIP E-MAIL ADDRESS
j_2_01-) 7 Avg fS L e-. _A.-/A �S/-•
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
f lD t- ■a �► lb _ i ra,t„F,_HALLsr D (a.33)333 - 1.4H2
MAILING ADD' CITY.STATE,ZIP CELL PHONE
vO�Iof / B?) �IYNTFFEDELAYBSNS/iENUM
,JEXPIRATION DATE O FAX
( 2 ) Q
CONTRATOOR'S REGISNUMBE EXPIRATION DATE
E-MAIL ADDRESS
�I ...6S N,A.1//40151 /gicli /U$ .� ..?p,- 51#1657-.
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
b.ii : /.mil. br ( ) --------
MA ING'.DR S CITY,STATE,ZIP CELL PHONE
( ) -
—
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑ Tenant ❑Agent 0 Other ( ) -
PROJECT i NAMET PRIMARY PHONE E-MAIL ADDRESS
CONTACT I 1 ( )
LENDER NAME Per RC'W 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 $— 31 1500
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO
WATER SERVICE PROVIDER Li LAKEHAVEN o HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
•
1110
•
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD , 3 7 f, 0
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT 0
EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PR.''- .SF TOTAL SF
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ q 000
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
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(ormb/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toilet)
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 application.
SIGNATURE: 1:7__ezC: "•44b ---------
DATE I?—7-60 7
Property Owner and/or Authorized Agent
FOR OFFICE USE ONLY
NEW ❑ADDITION n ALTERATION r REPAIR n TENANT IMPROVEMENT
BUILDING SHELL ONLY? n YES NO BASIC PLAN? n YES n NO
ZONING DESIGNATION CHANGE OF USE? ❑YES n NO
NEW ADDRESS REQUIRED? YES n NO UP/SEPA/SU? n YES n NO
PLATTED LOT? i I YES NO 1 DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100—August 16,2007 Page 2 of 4 k\Handouts\Permit Application