08-104992 iii, 1k
a 4 • CITYOF i / I ( 9 2
Gera! CEIVED PERMIT - -
COMMUNITY DEVELOPMENT SERVICES
SF MF CO ME EL PL DE E
333258TXAVENUE SOUTH•POBOX 9718
FEDE253-835-2607RAL WAY•,FAX WA 25980-8
363-935-
APPLICATION O N T 21 2008 TD / /
wwwcititofederatu ap.corn `n(Q�!
The folGiTi uFrr 4�t c �C�.`ancomplete application will not be accepted. Please print legibly(in ink)or type.
s.
e�,� • PROPERTY INFORMATION
SITE ADDRESS_ 3/ C� 3 ' 4 5, SUITE/UNIT# C
ASSESSOR'S TAX/PARCEL# L 5 ile - 00 / 0 LOT SIZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate pow for lengthy legal descnptioo)
I. PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING X FIRE PREVENTION SYSTEM
PROJECT DESCRI ION(Provide detailed descripti. of work included on this .ermit onl
0 04 (0.e, //'
501Z
17
PROJECT NAME(Name of Business or Owner Last Name) 0ev P ---- - �r 01-/,V/C
In PEOPLE INFORMATION
PROPERTY NAME /' � -
�l/r`/) PRIMARY PHONE
OWNER ( )
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
rift '.S AemiK , . Ale- , i-i-v/ --- (PS?)629‘ - 1`
CITY-STATE,ZIP __..._ -. CELL PHONE _...
/ /1 th `t e ,.- , - ( )
CITY 0 FEDERA W Y BUSINESS LICENSE NUMBER EXPIRATI N DATE FAX NUMBER
,Pi°60//?-87 /4- 'C /2 1 ( ) -
copY of card rogaioo OFFICE
CONTRACTOR'S REGISTRATION NUMBER EXPI TION DATE E-MAIL ADDRESS
44!',57
with each application iryF` /*V
APPLICANT Ca,PA MAPPLICANT NAME PHONE
teid,
gzeoes
hveto,
MAILI '�JJ AgDRESS CITY,STATE,ZIP CELL PHONE -
fJ�mi�/'r• 56W ( )
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant ❑AgentOther ( ) -
PROJECT NAME P��YPHjO�NEl� - E-MAIL ADDRESS
CONTACT j 1���L /-729A7e-il
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
ii DETAILED BUILDING INFORMATION s�tlrr �t
EXISTING USE PROPOSED USE f C /fes^4/ -`
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ ems) 49/4
SPRINKLERED BUILDING? "YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE o TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
{ SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
EXISTING PROPOSED TOTALTOT L TNG sr TOTALPROPOSED SF TOTAL sr
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.
MECh A1VICAL
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(mite)
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 ..../.."7-", .."' ,��., DATE
/a'./10 5?
(Signature) ,.."� (Title)
RELATIONSHIP TO PROJECT c O ❑ Agent ❑ Contractor ❑ Architect 0 Other
❑NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? a YES ❑NO
ZONING DESIGNATION CHANGE OF USE? ❑YES o NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES ❑NO
PLATTED LOT? o YES a NO DEMO PERMIT REQUIRED? a YES ❑NO
Bulletin#100—January 1,2007 Page 2 of 4 k\Handouts\Permit Application