11-102374 • 0
CITY CI RECEIVED 0 1 0 Z374,
Federal Way PERMIT SF MF CO ME EL PL DE EN FP
3372D I,POBOX°9 N 15 2.01A 'D
FEDERAL WAY,WA 98063-9718 / /
253-835-2607•FAX 253-835-2609
wlmu.darorrederalwau.ae r flV OF FEDERAL,.WAY
The following is required iation-an incomplete application will not be accepted. Please print legibly(in ink)or type.
IN PROPERTY INFORMATION
SITE ADDRESS aZtZ . et-.5/.et-.5/..lb ' 4E SUITE/UNIT# 2-7b
Ira-
i
ASSESSOR'S TAX/PARCEL# Z Jr & - p C., S-C> LOT SIZE(sf fl
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description!
■ PROJECT INFORMATION
,TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING J FIRE PREVENTION SYSTEM
PR ECT DESCRIPT�c��(Pyrovide detailed pscriiptio rk included on thispermit on I
/lll� 1., I er X.9)>Ek.li •— • -----:e-ht:Eli/ titi— 4 e-Eltia-441 5
PROJECT NAME(Name of Business or Owner Last Name) 1C4-4M✓ a41"IU - CEA-4EL.
• PEOPLE INFORMATION
PROPERTY P Y PHONE
OWNER j��C0/111) Perk-en S K ,Lx.1 _48c,c,
V, �� E (Oh L7gy i/ 1[A 'f& , ( E-MAILADDRESS
CONTRACTOR
.ii:MP ' N � SAP ICANT NAM OF CE PHO�?E ,
11 i 1 �C7ldlt.J p111�T Fl�.�l(-�/�.�'rq `t - f �
1 oG RFiSS(s4 W JTE,ZIP V Iae L ( {Gb1 .(E aLL )N7 -�t. 3.
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION I1ATE F NUMBER
jR —°000197-cr,�-3c. 12-31-z,(' ( )d3 - 77
C RA R'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADD S
rit fa
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROTECT FAX NUMBER
0 Architect ❑Tenant 0 Agent 0 Other ( ) -
PROJECT P Px NEz E-MAIL ADDRESS
CONTACT E'e (El�' JT (��g7 - - ,5�
LENDER NAME { Per RCW 19.27.095:
Lender information is required(f project value exceeds$5,000
MAILING ADDRESS CrIY,STATE,ZIP PHONE
( ) -
��,/ • DETAILED BUILDING INFORMATION Off-1?-6-
EXISTING
�-
EXISTING USE L.f'I'IGE PROPOSED USE «' -6- a
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ ' 141 q$4°
SPRINKLERED BUILDING? ji YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
S 0
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND (f-_) ) i
THIRD 1�
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
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.SYSI'EMS
PLUMBING
BATHTUBS(orrab/shower Combo) LAVS(BathroomSlnks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Collet)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I cert(fy that to the best of my
knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with all applicable
City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that the issuance of this permit
does not remove the owner's responsibility for compliance with local,state,or federal laws regulating construction or environmental laws.
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,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 plication.
SIGNATURE: ie., ( Cr 4-
DATE 6--1 -I I
Property Owner and/or Authorized Agent
FOR OFFICE WitOitur,
❑NEW ❑ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES ❑NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100—January 1,2009 Page 2 of 4 k\Handouts\Permit Application