08-100760 0,Ags. / 0 0 7 (c,
aeriWay 'REC6IVEDRMIT
COMMSTTY SERVICES r' MF CO ME EL PL DEE FP
-J3345 8fe AVENUE SOUTH PO BOX 9718
253-FEDE835-2835-607 FAX 453. 9718 09 FEBAPPLICATION T°
www.cittioffederalwau.com
The following is recni4e4I itihrnFtEig F co i�ltd application will not be accepted. Please print legibly(in ink)or type.
IN PROPERTY INFORMATION
SITE ADDRESS C)(i eCt✓I •> 41 r " /t( (c 5 3 Z` q t- 5•�' 9-I 6-201 SUITE/UNIT# 2-0I
ASSESSOR'S TAX/PARCEL# �, v o s o- �/ _Q .Q LOT SIZE(sj
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 Ftp 1(A—St s k"~
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING RE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
Vrrtrt K 1-^ct J1"ij FL-e 4ia t� SLJ >��v- (082...2 .
PROJECT NAME(Name of Business or Owner Last Name) GCGV\ c `)t/l
IN PEOPLE INFORMATION
PROPERTY NAME
4 ( ) �. PRIMARY;HONE -
OWNERL4- 'r � ✓�s ( I
MAILING ADDRE -. C/v ITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME 11 c APPLICANT NAME OFFICE PHONE
E:1,_ - VOtke Gov s-c ( cw - /4
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
'f o. ^� 33o 3 (�ctc�� �I . `�c 3 3 (3k) ) ( ( -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER I I EXPIRATION DATE FAX NUMBER
�U - DO - 1v IL( ( Z_ 31 -Q ( 30 )ac -
CONTRACTOR'S REGISTRATION rNUMBE/R EXPIRATION DATE E-MAIL ADDRESS
1- 1'fbi--7 I oc l� -t) • r Y - Cr!-- [";ICA,w-1C. .�Int.(L;')
APPLICANT COMPANY NAME APPLICANT NAME (`OFFICE PHONE
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑Tenant ❑Agent ❑ Other ( ) -
PROJECTNAME. PRIMARY PHONE E-MAIL
CONTACT e4 .1;e_ (�C'SS- 1-f- ( f '(? ) '394 _ 1S.
-)rtG
LENDER NAME S5SS�tI�,ulGtv2�'1C --rt�f.rl,t� t;C.1
, ,
PerRCW 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 $ .41/o.OL,
SPRINKLERED BUILDING? ❑ YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES a NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE a TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN a HIGHLINE ❑ PRIVATE(SEPTIC)
• PROJECT FLOOR AREAS
AREA DESCRIPTION • EXISTING PROPOSED TOTAL
SQ. FT. SQ.FT. SQ. FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRI: )
DECK(0 COVERED OR 0 UNCOVE•. D?) -'
GARAGE 0 CARPORT 0
NUMBER OF FLOORS EXISTING \PROPOSED TOTAL T•,, =WINO er TOTAL PROPOSED Sr TOTAL sr
"NEW HOMES ONLY" OF BEDROOM�
• ` E ,'MATED SELLING PRICE $
7 FIXTURES
Indicate number of each type of fixture to be installed or,elocci -d as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work$ (A COP/OF BID OR ESTI MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS E,"•ORATIVE COOLERS ` GAS PIPE OUTLETS WOODSTOVES
BBQS ANS G' z.,WATER HEATERS MISC(Describe)
BOILERS . FIREPLACE INSERTS HOO b (commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYS• MS
PLUMBING
BATHTUBS(orTub/shower Co LAVS(Bathroom sinks( URINALS MISC(Describe)
• DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAI SHOWERS WATER CLOSETS(Touot)
ELECTRIC WATE' ' EATERS 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 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 of this application.
f�11�� y
SIGNATURE: 111\41/ " ` DATE j ` / (
Property Ownir and/or Authorized Agent
t, ' , . -
'1 0 1 a `Y
a NEW a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
r
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a 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