08-101324 ARECEIVF p
cin of 0 ? — G / 3 oz V
Federal Way mmo 1cl 9 2Q08 PERMIT
COMMUNITY DEVELOPMENT SERVIC SF MF CO ME EL PL DEFP
33325 8TH AVENUE SOUTH•PO BOX 9718
253D8 607 F�3 3-20 F FE D E R4 VW I C AT I O N TD
www.rituoffederalwati.com
CDS
The following is required information-an incomplete application will not be accepted. Ple print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDR SS f+14 S 3 Ste" SUITE/UNIT#_
ASSESSOR'S TAX/PARCEL# ) 7 0 0 5- 0 - 00 g 0 LOT SIZE(sf I 7-4l e340
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ 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 onlu) ✓
ADD 1 I-Oat/A.404v F►tta Sre.►,akt.ar1S "R.C- New TtN)At-rr ywnP riovv PH,orT
PROJECT NAME(Name of Business or Owner Last Name) D Ce pti Std S44 1 4 (p�,LL,
• PEOPLE INFORMATION
PROPERTY NAME t n n oPRIMARY PHONE
�4
OWNER 5 4 11JUesr rpeP l S (jo3) z42.-2100
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
To `oX Z708 Toert 44JD, IAA 97Z4 8
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
HER s-erz4NKLegs toc. 5cAgr se'Sera (25'3)87 -cof`?
MAILING ADi4 DRESS
j�,� CITY,STATE,ZIP e�.//S.10 CELL
O`rPHONE
CITY OF FEDERAL AY BUSINESS LICENSE NUMBER �"eeEXPIRATION/DATE FAXNUM) t -126,8
( if,:. 10-0G. - 1004033-- odgL. ( 53)824. -to 33
COPY of card required CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL�`-AIADDRESSS!e�p� y� .�/�Q
with each appllcetion Fi r7*C) 1 V V iZ, t z/V 6 ,mac 1 ri[.,Siti N l�.WS .
APPLICANT COMPANY NAMEAPPLICANT NAME
54n R OFFICE PHONE C0141
(
MAILING ADDRESS ^„►'C CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMB ER
0 Architect ❑ Tenant 7g(,Agent 0 Other ( )
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT &(,i• Se L ere r (253 )SW - 00 19 Snore
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE (�
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 1 j &90
SPRINKLERED BUILDING? )YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER o LAKEHAVEN ❑ HIGHLINE ❑ TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER o LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
■ PROJECT FLOOR AREAS
AREA DESCRI •N_ , ._ ..._ ,,.,. ,. ,. .... „ ,, .. . .,„... ,..
ilal
•
PROPOSED
S•. FT. TOTAL
BASEMENT
S•. FT.
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE) .
DECK(0 COVERED OR ❑UNCOVERED?)
GARAGE ❑ 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 $
IN 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.
MECHAIVICAL
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
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS
(Toile[)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I
am authorized by the owner of the above premises to perform 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, 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 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.
NAME/TITLE ?(t65t.' I .. DATE 3" $ q • O 8
(Si
(Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent Contractor o Architect ❑ Other
FOR OFFICE USE ONLY
❑NEW o ADDITION o 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 1,2007 Page 2 of 4 k\Handouts\Permit Application