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CITY OF''.'�"""».vswa^` ^. 9� � v O ��•'/�j1 (0,
Federal Way p I-+,R M I T
COMMUNITY DEVELOPMENT SERs;' 3 2007 SF MF f 0 ME EL PL DE EN FP
33325 8r"AVENUE SOUTH•PO BOX 9718 p L I C A T I O
FEDERAL WAY,WA 98063-9718 • r-} Ar�eA,, N. TD
253-835-2607•FAX 253 4+e../1"'
urnw.cit uotTederalwa . �♦tt G DSif Ti V ( F
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
'. ' •' •' . .. ■ PROPERTY INFORMATION .
•
SITE ADDRESS \ j t 5. 'atit .161/4". J:&,,,a 'a SUITE/UNIT#Q-`Q7.-.
�-Z
ASSESSOR'S TAX/PARCEL# . 3 Z.. Q
-V l 0 41 LOT SIZE (sj)
LEG�L D S�ffIOI/1 a�g.iA,cl�e Estates, Lot 1 J 1 fl''1 ��1 ` V`S�t�Q !�?._.v., R._ e!^l�
(7 7 �J(J (Attach separate page far lengthy legal description) a
` ll ■ PROJECT INFORMATION '
TYPE OF PERMITUILDING ❑_ PLUMBING ❑ MECHANICAL
N
DEMOLITIO11] ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit wilt')
PROJECT NAME(Name of Business or Owner Last Name) \/ 0\G1,4.- l LC -' ( 0)7--
. • PEOPLE INFORMATION t •
PROPERTY NAME • •PRIMARY PHONE
OWNER A (.k�,& p�� �f�C.I� _ (;)-.1.X,) �u?= �72 4
M !LING ADVRESS CITY,STATE,•ZIP • - E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME • OFFICE PHONE
< 1 ,MAIpLING ADiD�RESS` CITY,�STATE,ZIP• 91•w.0. • CELL PHONEr . Q�
e , , I . - ..! to C \lsOlf. a-\,),... '+..}!. Y'�l�'. (flow-21s.i�.. - �,�.kj,"1 _
CITY OF FEDERAL• WAYBUSINESS, LICENSE NUMBER •
`\.EXPIRATION DATE FAX NUMBER ' •
' d CONTRACTOR'S REG STRATTION NUMBER-00 - �� E� TION E-MAIL 31 S. ��8� "
Lk
COPY of card re• S .� „�/
with dash appy I �.."YA�AA.✓ rw�-�.
APPLICANT ' COMPANY NAME - •APPLICANT NAME •OFFICE PHONE
MAILING ADDRESS - • CITY,STATE,ZIP CELL PHONE (
' RELATIONSHIP TO PROJECT . • FAX NUMBER •
❑ Architect ❑ Tenant ❑Agent O Other ( ) - .
PROJECT •NAME A PRIMARY PHONE E-MAILADDRESS
CONTACT - _ , V�""J `W-Ab1",--- .( ) 75. - crI).-'1'-'V S.ttv.c.,.
LENDER ZEA, Per RCW 19.27.095: '
Lender information is required if project value exceeds$5,000
• MAILING ADDR S CITY,STATE,ZIP PHONE
\3 kr 0. 4, 11k9WI Vc% V-w•14 1W4\• C"V%/K01. _ (`\- c) 6C:L - b')7'7
. •• ■ DETAILED BUILDING INFORMATION. •
•
. EXISTING USE \\110"..._,- PROPOSED USE 1 % .
EXISTING ASSESSED/APPRAISED VALUE $ � -VALUE OF PROPOSED•WORK $ . �WO,OD.
SPRINKLERED BUILDING? YES ❑ NO FIRE.SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER NLAKEHAVEN 0 HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER '.LAKEHAVEN . 0 HIGHLINE 0 PRIVATE(SEPTIC)
• r ■ PROJECT FLOOR AREAS
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. P• not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUS :E INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPI.'•TIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INS HOODS(commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SET REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) L• (Bathroom Sinks) URIN MISC(Describe)
DISHWASHERS •• NWATER SYST VACUUM :•EAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOS (Toe)
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 +,' \�►__�—�� • DATE
_
.4,l_nature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner 0 Agent Contractor 0 Architect ❑ Other
a NEW a ADDITION ❑ALTERATION a REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES ❑NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES a NO
NEW ADDRESS REQUIRED?_ o YES ❑NO UP/SEPA/SU? ❑YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES o NO
Bulletin#100—January 1,2006 Page 2 of 4 k\Handouts\Permit Application