07-102077 1 lia
RECEIVEY Of 1L 0 _
Federal Way i2 ( -z 0 -r 7
APR I S8 2007 PERMIT SF MF CO ME EL PL DE EN '
COMMUNITY DEVELOPMENT SERVICES
33325 8"'AVENUE SOUTH•PO BOX 9718
2 3-835 2607•FAX 253-835 2609 L WAY,WA 98063-90TV OF FEDE , LI C AT I O N T° / /
www.cituoffederalwau.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_ 3< o ' IL-P I I �`-Q It SUITE/UNIT# '
ASSESSOR'S TAX/PARCEL# 2'Z t0 ' 6 co - 6 D 2- fl LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
IN PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTKICAL ❑ ENGINEERING x
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlut)
V' •f yet i'-) j v l ‘..t,,,,-."„„ s S 4-4-4n. ,' lj /LQii./ d C'
,� 'wA ka.`" V
PROJECT NAME(Name of Business or Owner Last Name) Yr- t 0(A-4-""---e- J 42-1"--e-
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL.ADDRESS
CONTRACTOR COMPANY , AP CANT N E OFFICE PHONE
�`' �` ��►' 1/r�e�"'Y t t ( Zi4 ) s 1-5f -10 6'
MAILING
E
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AfVJA O)
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CITY OF FEDERAL WAY BU INESS LICEN MBER EXPIRATION DATE FAX NUMBER
2..00 idf81( _co �-�- ISI.) Ir? ( Za''I ) 3Zq - 91937
COPY of card required CONTRACTOR'S, qp� /� REGISTRATION' NUMBER EXP TION D TE E-MAIL tt�+.D(RESS /'
with each application 1 > )V V/K I \ to_ 1 /V O g q 2 (J 7 A b" e A> 1€ eeik
/ V` J t
APPLICANT COMPANY ✓E j APPLICANT NAME OFFICE PHONE
1I1.�/1c_f G� ( )
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT ,tFAX NUMBER
❑ Architect o Tenant ❑Agent El Other C -"t dt cit'/ ( ) -
PROJECT NAME_ PRIMARY PHONE E-MAIL ADDRESS
CONTACT ��YoI C' i'I` .5 ( Zen ) .7i 3 -7 i �j ii fjei"- 5 �n St'I -le;co"
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
U DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ () Cit 0
SPRINKLERED BUILDING? ❑ YES 7 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES q.NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE o TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN o HIGHLINE ❑ PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
r _
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
/„,
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
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 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 I ERTS HOODS)Commercial)
COMPRESSORS FURNACES = RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bgthmom NNN URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SIOWERS WATER CLOSETS(Toilet)
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.
/)1/ }
NAME/TITLE � DATE I/ ) /4"
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner ❑Agent 9 Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
NEW n ADDITION n ALTERATION n REPAIR n TENANT IMPROVEMENT
BUILDING SHELL ONLY? D YES c NO BASIC PLAN? c YES c NO
ZONING DESIGNATION CHANGE OF USE? ❑YES c NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100-April 2,2007 Page 2 of 4 k\Handouts\Permit Application