07-106351 O •
1 FY OF A. RECEIVED
ederal Way `�61 - D 42_ 5L
COMMUNIIYDEVELOPMENT SERVICES N O V 2 6 2007 PERSF MF CO ME EL PL DE EN P
33325 8TH AVENUE SOUTH•PO BOX 9718
FEDERAL WAY,WA 98063-9718 r iFAPP LI CATI O N
C
253-835-2607•FAX 253-835-2641 FY " F'EL E.
www.cituotfederalwau.com BUILDING DEPT.
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION ^�
SITE ADDRESS i 4 .(,p 8 c -"t tel j�v SUITE/UNIT#_(xC
ASSESSOR'S TAX/PARCEL# ( ¶ O0 S - ' C) 0�j LOT SIZE(SM
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) 0 trig tin ()L',3 } i
(Attach separate page for Lengthy legot description)
E PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING , I FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
\"c? i 1^1 .
PROJECT NAME(Name of Business or Owner Last Name) `J C,(;('k,.11 1`�.R
PEOPLE INFORMATION
PROPERTY N E [4 PRIMARY PHONE -
OWNER • y 1�� I 4.2T1;t�ST.I ( )
MAI ING ADDRESS IP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
e r i—tc.c d cued Duct- tonext r- L )"}eta - 4-6
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
(JACO icerr` Cl4x. > `. Y:0,1a CUR * %aiCha ( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER E}iPIRATION DATE FAX NUMBER
C1 qt.'s f b'�Sci I O rJ ( ) ��o' - t,1G}-
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
12:11-CC D*-0 6 C L I SI t �-'
APPLICANT COMPANY NAME APPLICANT NAME
OFFICE PHONE
�r�xn a." 4bcV f:. ( )
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect ❑ Tenant 0 Agent ❑ Other ( )
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT -1 i` tex\ fTIAnc2.)Vl(_k ( '' ) 'c - Cf‘A'6,
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
IN DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
C9
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 34,2.00
SPRINKLERED BUILDING? ❑ YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
• 111
MI PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
■ 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 Si.-- MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(commerciap r 1(=,
COMPRESSORS FURNACES RANGES 0 reoe,n ncn/
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Taint
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. /
ky,
SIGNATURE: CSI -1�.-�,-. e___.4-/\--_____..iDATE `I l/C1 --
Property Owner an /or Authorized Agent
FOR.OFFICE USE ONLY
C NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES ❑NO
ZONING DESIGNATION CHANGE OF'USE? o YES o NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? o YES o NO
m
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100-August 16,2007 Page 2 of 4 k\Handouts\Permit Application