07-102118 II •
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Federal way PERMIT
COMMUNITYDEVELOPMENT SERV Flit 2 0 Inn? SF MF CO ME EL PL DE E� FP
3332E D AI
L WAY, ATH•63 97 APPLICATION
FEDERAL WAY,OWAU 98063-9718 1n / /
253-835-2607•FAX 253-835-2609
www.cituoffederalw7-,corn y OF
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The following is requ`ille�tii4tl't�f/►ttltioii-an incomplete application will not be accepted Please print legibly(in ink)or pe.
• PROPERTY INFORMATION
SITE ADDRESS_ ?).?)1\` 0MM 9114 AVE S SUITE/UNIT# %14
ASSESSOR'S TAX/PARCEL# 92 (O 5 0 1 - 0 0 C, O LOT SIZE(s) 8 5,..?)54
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) CO W a.S i CAl'rWc)S ocFiCE PARK ON .Z
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT ❑BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
ADD (112ELocATE SPIZU-3K•La1ZS FQiZ ) ELAJ QEiLii G 7
vV AV ori___ -2 L AL
P,O���� / i
PROJECT NAME(Name of Business or Owner Last Name) ) 0 (./T/L
• PEOPLE INFORMATION
PROPERTY NAME ((''�1 , ► _ q _ PRIMARY PHONE
OWNER So -+0 v rJ,2 E3 (la)22 5 -95c:°
MAILING ADDRESS I CITY,S7A1E,Lir E-MAIL ADDRESS
'320 \0( TH RvE 0E-44-10011, .LE\JUE WA-53004
CONTRACTOR COMPANY NAME APPLICANT�ME OFFICE PHONE
H IRE. S`?STEMS wES( (3VA STEwAv12i (y53)S33 - \2.42s
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
'119 I 1rP k',0 iJ 1113 PAC-ic t C t-4)'\ 9e044-7 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
''f) --` .7—c ao14—o0--3L 12%31 iol (1. _;3)-735 -o03
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
COPY of card required I w
'th each application •J F\12.E s ` k 1 40 ai :0/12-
/0�
APPLICANT COMPANY NAME W ` APPLICANT NAME G / OFFICE PHONE
F.-112E 5`?S T E AS w a-5.7 l c‘#A, S-Cr ZAJk121- L25,5)833 -i Zetca
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant Agent 0 Other ( ) -
PROJECT NAME ..... PRIMARY PRIMARY PHONE E-MAIL ADDRESS
CONTACT 6i) S-c E(A. 'T C ( .1:)--, ) ' 1'' - 12-48
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 $ 2X34.00
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN n HIGHLINE o PRIVATE(SEPTIC)
• ,
J' a
U PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST hh
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)_
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGEi ❑ CARPORT CIN V MBER OF FLOOR) 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 2 232.00 0O
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(eommereiap
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(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 o iters and employees,upon the accuracy of the information supplied to the city as a part of
this application.
t •
NAME/TITLE
n
' DATE 1 7 /
01
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner "liicAgent a Contractor D Architect ❑ Other
FOR OFFICE USE ONLY
❑NEW n ADDITION ❑ALTERATION n REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? a YES ❑NO
ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? o YES ❑NO
PLATTED LOT? ❑YES a NO DEMO PERMIT REQUIRED? o YES ❑NO
Bulletin#100—April 2,2007 Page 2 of 4 k\Handouts\Permit Application