08-103738 RECEI. ..r -
cln of 1..1_ / 0_ , _23
FederalWay PERMIT 1111i-
COMMUNr1YDEVELOPMENTSERVICES' G 0,6 ZOOS, SF MF CO ME EL PL DE E FP
33325AVENUE SWATH•PO BOX 9718 ,L I C AT I O N
FEDERAL WAY,WA 98063-9718 TO - / /
253-835-2607•FAX 253-835-2609,Ty OF FERE RAP,
www.cituoffederalwau.corn
CDS
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS t.() 5 4-1--� 3 �S--irtZ � SUITE/UNIT#
ASSESSOR'S TAX/ CEL# 0 7' 23 0 k-, 1p
1 - 1 0 a LOT SIZE(sj)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
a PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detaileddescription of work included on this permit only)
A r0Y o (<(2-;ti(A V' 9*" z�-
PROJECT NAME(Name of Business or Owner Last Name) ` ( (..7„) RG" ,��� V(1/1,1— 5 5+'
II PEOPLE INFORMATION
PROPERTY NAME
/ PRIMARY PHONE Y
:::-41
0 ' ra -- ) SF�
- (
_
Z --
MAIL-G S J CITY,STATE,ZIP E-MAIL ADDRESi � 0'11,1- G r-
k...... g.-.<Gr.,(7/-64( tVek) 91F(163 - 531 7
CONTRACTOR COMPANY N E APPLICANT NAME OFFICE PHONE
L ) 1 . c� 6Co pa.,-, II -tit/
MAILING ADDRESS l r:: ) E -` �
r + COY,STATE,ZIP CELL PHONE
3 S t 4- )f c f i t�)kTtf?(1( ; (.,s3 ) yoc -7(?`s
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXP{RATJON DFAX NUMBER
2-0 0 I ‘ Lq-'00 3� i 2/3/1/0 ( 3 )'i722 -Lf5'?
CONTRACTOR'S REO TION NUMBER .•IRATION DATE E-MAIL ADDRESS
(--)rd:-( (: / (Y (,-7 Vii/or _,;, ,.. e 1r),d.: In .P opt, .4)P/
APPLICANT COMPANY NAPPLICANT NAME OFFICE PHONE
MAIL
tA7I ``NG ADDS'cid 5 `�.C pa✓t J CITY,STATE,ZIP ( )
CELL PHONE
RELATIONSHIP TO PROJECT )FAX NUMBER
0 Architect 0 Tenant 0 Agent 0 Other ( ) -
PROJECT NAME �y PRIMARY PHONE E-MAIL ADD�
CONTACT COtfc.xC—.),,'- - (Yp(4x3,69f ��wS ) ciG�cc - I'
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP (HONE
IP ) -
■ DETAILED BUILDING INFORMATION
EXISTING USE R.&. --��,,-.nk- /1!
PROPOSED USE C.5 �/dtA;"
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ / 01(()-0
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 0 LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
i PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ. FT.
BASEMENT
FIRST
SECOND
THIRD /
ADDITIONAL FLOORS(DESCRIBE) X
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
smarm PROPOSED TOTAL TOTAL=STING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBERhp 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$ (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 URINALS MISC(Describe)
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom Sinks)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(i oilet)
L____
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 aris out of t a reliance of the city, including its officers and employees, upon the accuracy of the information supplied to
the city as a part applic on. j
SIGNATURE:
i 1 1
-- ✓' DATE
Property_Owner and/or Authorized Agent
.//' 4
❑NEW o ADDITION
❑ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100—January 1,2008 Page 2 of 4 WIandouts\Permit Application