06-100437I
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V
Federal Way PERMIT
COMMUM7YDEVELOPMENTSERV/CES I N �,J
333x5 DERALWAY.W71if•PO971C9718 J�' ,ICATION
FEDERAL WAY. WA 98063-9718
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ILDING DEPT.
Thefollowing is required enation - an incomplete application will ni
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MF CO ME EL PL DE EN FP
Please
or
SITE ADDRESS /� SUITE/UNIT .#
ASSESSOR'S TAR/PARCEL # - ck —0 —0 LOT SIZE (Sf
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) it
(Ad -h vases br kl9wi kqW dear.prb J
PROJECT•
TYPE OF PERMIT )<XUELDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed d4(sction of work included on is it onn
V) A � n a A rA ivy► � I _ h D .n.� /r! D.44-1-1 Di �CIII�• .�-„��
PROJECT NAME (Name of Business or Owner Last Name)
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
COMPANY NAME _ FirL
AME OFFICE PHONE
k Ho e s (yam y(� -
ING ADD ITYELL PHONE
1too! �9a1�( _
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
_ _ — -_ _ _ _ _ _ -B L , -�b/3
CONTRACT'OR'S RF.GISTRATIOpi NUMBER (copy jai card repaired with each application) EXPIRATION DME
L g5y�1-M x-7//5/07
C MPANY AME `_
iC N
OFFICE PHONE 6
-I 3I
ADDRESS
C T ZIP
CELLPHONE
7 . 11 _1
L V
( )
-
RELATIONSHIP TO PROJECT
Agent Other (Describe)
FAX NUMBER
(V. -b-) �J
�
-
Architect ❑ Tenant ❑
Y
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINHLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO
WATER SERVICE PROVIDER ❑ LAHEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER 0 LAHEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
SQ. FT.
BASEMENT
o NEW o ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
FIRST
BUILDING SHELL ONLY?
o YES o NO
BASIC PLAN?
SECOND
o NO
j
11
f
THIRD
❑ YES
o NO
NEW ADDRESS REQUIRED?
FOURTH
IIP/SEPA/SU?
o YES
o NO
ADDITIONAL FLOORS (DESCRIBE)
o YES o NO
DEMO PERMIT REQUIRED?
❑ YES
DECK (COVERED?)�---
GARAGE CARPORT ❑
NUMBER OF FLOORS
Tori
rorwccomma w
�%
"TA
**NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
ANICAL
of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG. SYSTEMS
BBQS FANS HOODS (c®, ciaJ WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC (Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
G
BATHTUBS (o TUb/shower combo) SHOWERS WATER CLOSETS rroueJ MISC (Describe)
DISHWASHERS �_ SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS (Bath— Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
I cert(fy under penalty of perjury that the injbrmation furnished by me is true and correct to the best of mg knowledge, and further, that 1
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,Jiled 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 Irtformation supplied to the city as a part of
this application.
NAME/TITLE
RELATIONSHIP TO PROJECT
Owner )( Agent
(17Ue)
Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
o NEW o ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
o YES o NO
BASIC PLAN?
o YES
o NO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
o NO
NEW ADDRESS REQUIRED?
o YES o NO
IIP/SEPA/SU?
o YES
o NO
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
Bulletin #100 —January 1, 2006 Page 2 of 4 k\Handouts\Permit Application