06-100118 • RGccier
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PERMIT ern,of SF MF CO ME EL PL DE EN P
COhIMUNITY DEVELOPMENT'SERVICES
fi'ED >
33325 8"'AVENUE SOUTH•0 BOX 5718 AP P LI CATI O NSU«DfNG�EpT,A.Y L53835FEDERAL 07*FAX.WA 53 835.2 0 / /
253835.2607•FAX 253-8352605
www.c1tyoffederalway.com
The ollowin! is re•aired i ormation-an incom•lete a• •lication will not be acce•ted. Please •rint le!ibl. in ink)or •.
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• PROPERTY INFORMATION
- /
SITE ADDRESS �'v // L� Q'G/� G / / SUITE/UNIT#
4:1
�!
ASSESSOR'S TAX/PARCEL# I (LL 4 C� 1) - 1 o J LJI 6 LOT SIZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
lAllac'h separate page 1px lengthy legal clescrlplbal
• 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 onitl)
FIRE _SPRINKLER ( ENAHT /M 'iRVEMENT ADD H
SPf( NII<LECZS.
PROJECT NAME(Name of Business or Owner Last Name) Li H I /I G V LC/IPA N(
El PEOPLE INFORMATION
PROPERTY NAME I— EO'-JA'-1 A5 S DL.I A TES PRIMARY PHONE
OWNER G-RAMGR DEVEI I)PhENT i N VESTDIZS (ZG(') Z84 -4Q(
MAILING ADDRESS CITY.STATE.ZIP
150.5 i JESTLAI(E AVE*. 32 SEAT[ LE \JA aBfZ�f
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
LOSCD FIRE PRO T FrTION 131Z1AH SCHUL7 F (4-25)BZ7 �f� -
MAILING ADDRESS CITY.STATE.ZIP CELL PHONE
1 ) (0 I17T4 PL IyE KCRKLANu wA ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBERt,j EXPIRATION DATE FAX NUMBER
UO
2 D - D I - i 0 I 8 89�- B L iZ / 3I /DL (42.5)827 -7474
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
QEP_ 1LQE ( 2 /3 ( /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
C�OVo FIRE PfZU( t1t(D!{f B31Z(AM SCI4()LaE 425)827
MAILING ADDRESS CITY.STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑Tenant 0 Agent 0 Other(Describe) R RE SPIZ(fftl<LC.R (425 )827 -7474
CONTACT NAMEPRIMARY PHONE E-MAIL ADDRESS
132(/sH C/ H UL-2_E (425) 827 -q-f-1054
LENDER Per RCW 19.27.095• Lender information is NAME
required if project value exceeds;$5,000
MAILING ADDRESS CITY.STATE,ZIP PHONE
■ DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE E Li OFFICE_
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 3 �p
SPRINKLERED BUILDING? )(YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? AYES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN o HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
••
•
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
sg. FT. Sg. FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
NUMBER OF FLOORS EXISTING PROPOS® TOTAL TOTAL EXISTING SE 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 $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS icommrrri,n WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DULLS GAS PIPE OUTLETS
PLUMBING
BATHTUBS k,rTub/Shim rrComl.) SHOWERS WATER CLOSETS rrnurn MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLK1S SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
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 � l DATE -
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent ❑ Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY . .
❑NEW c ADDITION o ALTERATION a REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? 0 YES ❑NO BASIC PLAN? o YES ❑NO
ZONING DESIGNATION CHANGE OF USE? a YES c NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? c YES a NO
PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? ❑YES a NO
Bulletin#100—January 1,2006 Page 2 of 4 k\Handouts\Permit Application