10-101238 —
CITY OF / 0Federal Way ECEWV I T MF
ERM
IT
COMMUNITY DEVELOPMENT SERVICES
33325 D AVENUE,SOUTH 9•PO 971 97 MAR 2 5 201 P P L I C AT I O N •
FEDERAL WAY,WA 98063-9718 TO
253-835-2607•FAX 253-835.2609
www.c,tloffedernlwatl.com -
of FED 'WAY
The following is rgiltgeninlleagsatioation-an incomplete application will not be accepted. Please print legibly(in ink)or type.
C� ( /�R PROPERTY INFORMATION5-11-601--.
Q
SITE ADDRESS_ `- 1 ✓ S `A . 2 i �-/1 'r 60/ SUITE/UNIT#_
ASSESSOR'S TAX/PARCEL# 0 17 ` 0 1 - 9 � -4 ✓ LOT SIZE(sJ)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) 1h4-0 1 11" MtPO4-E'S gi 00—
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 'X FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
IAtOIL vP CAC-rv►lort-- if1Sc, 14,00D w+7ua' Su'PPtriesSi,R-► Sys
-TO .?R6--f tPct 0,00_9
PROJECT NAME(Name of Business or Owner Last Name) LATK+ I 1 1' i)D I .E sJ 1 OO L
• PEOPLE INFORMATION
PROPERTY NAME - PRIMARY PHONE n
OWNER P&DCI wily scum_ ,MST (ZS3 ) 945 -2")
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
31'405 187a S + -tt et- Nj/(AA 9b0)3
•
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
500E9'50° S SP,C41 C,Af4 WMAIM)• ( '?JD ) 3 0- 430
MAILING2400 RA1S
uvill S - CITY, ,ZIWig "„ I3� CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATIONC✓D�ATTTE FAX NUMBER
1g-99 —.to(a0�e2-00-51_ 12(31 J7 D ( ) 3` 0431
COPY of card required CONTRACTOR'S REGISTRATION NUMBER EXPIRATION P/ATE E-MAIL ADDRESS
with each application I > 5A E 5514 c y\ (,//%/ It
APPLICANT COMPANY NAME J✓ (/f`V APPLICANT NAME V �/ OFFICE PHONE
5 eg'5 CaT L- ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT FAX.NUMBER
❑ Architect 0 Tenant 0 Agent ❑ Other ( ) -
PROJECT NAME PRIMARY PHONE, \ E-MAIL ADDRESS
CONTACT CA g,,i woui"I Ol ( 7.4%) Jl,i 4, '
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 ' 00
SPRINKLERED BUILDING? ❑ YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? `iCYES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
tiKW!,I1/:ac:K11'r1UN EXISTINNG PROPOSED TOTAL
SEIT. SQ. FT. SQ.FT.
BASEMENT41P-10 •
FIRST •
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE) _
DECK(❑COVERED OR 0 UNCOVERED?) •
GARAGE 0 CARPORT 0
=Term PROPOSED TOTAL TOTAL EXISTING Sl TOTAL PROPOSED Sl TOTAL Sl
NUMBER OF FLOORS
•
•
"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 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(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.
NAME/TITLE
4e..,,,,,9„..- DATE 2/ 1Q/ 0
f
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent Contractor ❑ Architect ❑ Other
•
o NEW a ADDITION o ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES a NO . BASIC PLAN? . • o YES a NO
ZONING DESIGNATION CHANGE OF USE? o YES a NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES a NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? a YES o NO
Bulletin#.100—April 2,2007 . Page 2 of4 k\Handouts\Permit Application