08-104489 wv CE/VIOD - * 1
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PERMIT
OOMMUM7YSF MF CO ME EL PL DE EN
33325 Sri DEVEWPMENTSBR AV DEESOU1N•POBovi�tsp 21 2U08APPLICATION
FEDERAL WAY,WA 98063-9718
253.835-2607•FAX 253-835-2609 I
www.d`wrirrOF FEDERAL WAY
The following is require Smation-an incomplete application will not be accepted. Please print legibly(in ink)or type.
PROPERTY INFORMATION
SITE ADDRESS /C�`�-,tp/ $ 3 2 CD 5I... SUITE/UNIT
ASSESSOR'S TAX/PARCEL# G 'S G cr 5 - O LOT SIZE(sfl
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach sfixuatePage lbr WOW d1
NI PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING k FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
/Ve`uo ULL -?®Q F'► - SrtpP C.Ijvi S/J'IP ,1.
PROJECT NAME(Name of Business or Owner Last Name) Ti--) fry 0 k 1.)60
U
• PEOPLE INFORMATION
PROPERTY A jfinV D PRIMARY PHONE
( )
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
CO -CTOR COMPANY NAM�1Ek� APPLICANT NAME j OFFICEE PHONE
MAILINGADDDRE33 �SYL�/G//cC��7 OV'Yc`‘ (<l36 )�I� l(
)_ _ STATE,ZIP 9 CELL PHONE)
5F FEDERAL I"- E \° rt�ti1 vst 9 O ` ((K� )fiS"�.r
CITY O WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
�
' (53 )43 'ZQJ'
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
�Y'2vik r' 921r' Co o1_ '70
449
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
�Y}T11 k c-Nre p-yri*Ti".e r � Y‘ (a)(.
MAILING ADDRESS C ='Lai ITY,STATE,ZIP CELL PHONE
5:A) :•
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑Tenant 0 Agent 0 Other
PROJECT NAME PRIMARY PHONE _
CONTACT E-MAIL ADDRESS c-\,‘ �- 5�1 (424 )22'4' 4'a
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds 55,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
)
■ DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ C'6Grf °
SPRINIILERED BUILDING? a YES t"NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? YES 0 NO
WATER SERVICE PROVIDER a LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAKEHAVEN ❑ HIGHLINE a PRIVATE(SEPTIC)
• 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
Manila PROPOSED TOTAL TOTAL ESf87SY08J TOTAL PROPOSED sr TOTAL Sr
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 / 6 U ...
Value of Mechanical Work$ r , (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 Icomma<aq .
COMPRESSORS FURNACES RANGES .
DUCTS. GAS LOG SETS REFRIG.SYSTEMS
PLUMBING URINALS MISC(Describe)
BATHTUBS(or Tub/Simms combo) LAVS(s.►nroom somal
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
•
DRINKING FOUNTAINS SHOWERS WATER CLOSETS iroueq
•
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
•
•
SIGNATURE
I certify under penalty of perjury that I am the property owner or authorised 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 authorised 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 ofthisapplic on. (�
SIGNATURE: :?.....,1✓ `/.� DATE 6-, 2.3 4
d
Property Owner and/or Authorized Agent
•
•
a NEW a ADDITION • a ALTERATION a REPAIR a.TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? D.YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? D YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO
•
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application