09-100815 1 p
CITY OF -� ' 9 1_Q6
Federal Way MAR Q4 PERMIT
COMMUNITYDEVELOPMENT SERVICES �",^,:� SF MF CO ME EL DE EN FP
333258 AVENUE SOUTH.PO BOX 9718 LI C AT I O N
FEDERAL WAY,WA 98063-9718 ,4*,.
��� To
253-835-2607•FAX 253-835-2609 /
www.digojfederdwau.com �r)C` Ale.
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The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
1a PROPERTY INFORMATION
SITE ADDRESS "30 FS i > $' t
bile'L` Z''ySUITE/UNIT#_
ASSESSOR'S TAX/PARCEL# Q O Z i ® 7 - -(/� d 5. LOT SIZE(st)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal deaoiption)
MI PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING d PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit on(v)
i( / f�1ooe aPg,9 iV a/? ii riyia.A-1-
eozo CA 1z5- 2. Sme k<-S
e ' - 7-011_6-7- i7411) lis-t./
PROJECT NAME(Name of Business or Owner Last Name) ,7 / $
f 34-6 __'e‘ti6p cf-t---it 2
U PEOPLE INFORMATION
PROPERTY NAME ti PRIMARY PHONE
OWNER MAILING'\/ `� (5 , (ifn-1 c/I 7 - 77cwt
ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
e.0
0. `ret,,'114,1----cr UW LT'30 0 Si,../' i r... ;;t /4 1 C/-1'
CONTRACTOR COMPANY NAME APPLICANT NAME
HO
E OFFICPN
/=1E?4t En,r fThrr-/01/-77-',414-i(/1 ,4-t r-" ', ( r. ),>>- l /L
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
•fn1ft, l ii.'i)t�f ` *' r I ( tr ,.j) .:d(G -7335
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
�� ( ) -
\\ �T) CoairsREGISTRATION MOM EXEMIATION DATE E-MAIL ADDRESS
U C Z-76,--5/12 l'e/ ,t/z,/ .57 7-4,/0 `;
APPLICANT COMPANY NAME
APPIJCANT NAME OFFICE PHONE
i -12'-Zxl Ste`" (c L ; ,r_ (`--6?U3 - (- '> ) f '> -� //
MAILING ADDRESS CITY,STATE,ZIP �( j
CELL PHONE
i t -` -s_. i�N%�'1 (31,,1 r j /y KO'I ( 3 )4,04 ....73
333 -'.
RELATIONSHIP TO PROJECT FAX NUMBER
C Architect ❑ Tenant o Agent IS Other 51Ig 51I40't?Y'r2L ( 3� )73'5---/'3 'Z
PROJECT NAME ,jr PRIMARY PHONE
CONTACT CQI44--- &((�.ex_ E-MAIL ADDRESS
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
(
a DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
MI PROJECT FLOOR AREAS
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 ( `
NUMBER OF FLOORS SXLSTLSO PROPOSED TOTAL TOTAL EZISTINO sr TOTAL PROPOBLO SF TOTAL Sr
**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.
IIIEC&ANICAL
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(Commnaat)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo( LAVS(Bathroom&dm) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS 1 SHOWERS WATER CLOSETSloo>r � 1�
(rose)
ELECTRIC WATER HEATERS Z 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: DATE 0,
• •perry Owner and/or Authorized Agent
a NEW a ADDITION a ALTERATION a REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a YES a NO
ZONING DESIGNATION CHANGE OF USE?
❑YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? a NO i(
Bulletin#100—January 1,2009 Page 2 of 4 k\Handouts\Permit Application