08-102078 RECE (ED
4111)
41/4
CI OF APR 3 0 2008 J/-_ 2 Q
Federatway PEPMIT
COMMUNITY DEVELOPMENT SERVICES CC rt SF MF CO ME EL PL DE EN P
33325 8m AVENUE SOUTH•Po BOX 9718 FED Dt 1I C AT I O N
FEDERAL WAY, 98063-9718 TO
253-835.2607•FAX 253.835-2609 CD. -----/
wwwa tuafedernlwn u.rnm
The following is required information-an incomplete a••lication will not be acee•ted. Please print legibly in ink)or type.
�7f, ( ■ PROPERTY INFORMATION
SITE ADDRESS 19 L 3 2 N U:YY1YhJoi j U
SUITE/UNIT# � ��
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) :-'3;I'I ,e,
(Attach separate page for lengthy legal description)
In'PROJECT INFORMATION
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 onlq)
f P--.(=:)(FAD ht
PROJECT NAME(Name of Business or Owner Last Name) 5 bIrcuw 15
m PEOPLE INFORMATION
PROPERTY NAME
PRIMARY PHONE
OWNER ( )
MAILING ADDRESS CITY,STATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
S Ocr3u , f-or/ "j(ut-C.- .- (- . ) 1`6 - 13`
MAILING ADDRESS CITY,STATE,ZIP t CELL PHONE
2,1u f1��,(''„ G4�9'`( Sc 1 I- ./ (3`j (- ) -
CITY OF FEDERAL WAY BUSINESS LICENSENUMBER EXPIRATION DATE FAX NUMBER
AT-_ ! ° /? (2,0 BL 1v >1 / O (24 ) 4�, - 13I
/
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each appliction) IRATION DATE
--\! 1J <---1 l) t,''''t-.1 (e7/O7 1(///�
APPLICANT COMPANY NAME 4..c,
, �/� APPLICANT NAME OFFICE PHONE -
MAILING ADDRESS r ( )
CITY, STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect 0 Tenant 0 Agent ❑ Other(Describe) ( )
CONTACT NAME /evl PRIMARY PHONE
E-MAIL ADDRESS
LENDER : ,VeSCr,--,--/ ., , -,x Y' 40,,y,myo,7pN ;'K NAME
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
■ DETAILED BUILDINGINFORMATION':
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE VALUE OF PROPOSED WORK $ '�'" >`�'�-'9
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
• S
TOTAL
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED
SQSQ.FT.
'BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT O
mama
lROMe�O TOTAL "".Y 6_�.? .., .(•� <,r°
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 $
EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BOILERS
AIR HANDLING UNITS WOODSTOVES
BBQS FANS HOODS(Commercial
FIREPLACE INSERTS RANGES •
MISC(Describe)
•
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING MISC(Describe)
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS QoeeQ
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SY3T
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom 9b*4 VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the inform:off;n furnished by me is true and correct to the best of my knowledge,and further that I
am authorised by the owner of the above premises erform 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, expanses, 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.
4 &1:(1 _,.,. .,,. DATEl 1,3NAME/TITLE (Tine)
(signature)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent ❑ Contractor ❑Architect 0 Other
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r)..11.4.4,lit AS Tanuary 1 9(106 Pace 2 of 4 k\Handouts\Perinit Anolication