06-100436i O� � mis federalWay OCOMMUNITYDEVELOPMENT SERVICES /�,33325 8 -AVENUE SOUTH • PO 80X 9718 AFEDERAL WAY. WA 98063-9718� `I: ATI O N
253-835-2607• FAX 253-8352609
unou+.dituoffedera&au.mm � 0 F' F L C) E R
jL WING DEPT. '
The tollowina is reauired in a - an incomplete application will not be
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ted. Please print leaiblu fin ink) or tune.
SITE ADDRESS --,, SUITE/TmT •
ASSESSOR'S TAR/PARCEL t J -v - LOT SIZE (Sfl
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) —
(Amuch P.W.fa kmw kwd d—rfpu-v
PROJECT INFORNIANON
TYPE OF PERMIT )<BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed ksc tion of work included on is ll
on
' n
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
047
(Name of Business or Owner Last Name)
MAILING ADDRESS r�+�
�a�I-ria}"tee5 /Ly �Vl R bO
COMPANY NAME. r�'.U NAME OF�%FIC�E�PjRONE -
Homes
ING ADD"Fly. TE. W ELL PHONE
I (0y q7 A4kk-
CnY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE F�At�XNUMBE/R `//
CONTRACTORS REGISTRAMOY4 NUMBER (copy 0 card required with each m"n—u6n) EXPIRATION DATE
L . 0-7//
MPANY AME �.
Cr
IC . N
OFFICE PHONE j
(Y /lr�
-
rlyT ZIP
�(
V
CELL PHONE
( )
-
RELAMONSH W TO PRQIECT
❑ Architect ❑ Tenant Agent ❑ Other (Describe)
FAX NUMB
(VOQ
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
• 0
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
89. FT.
BASEMENT
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
FIRST/i
BUILDING SHELL ONLY?
❑ YES o NO
BASIC PLAN?
SECONDCT(J
❑ NO
ZONING DESIGNATION
THIRD
o YES
❑ NO
NEW ADDRESS REQUIRED?
FOURTH
IIP/SEPA/SU?
❑ YES
❑ NO
ADDITIONAL FLOORS (DESCRIBE)
❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
LaDECK
----- —
AXW u - OMM zya-.+..
NUMBER OF FLOO,ca
•
Tmrwa eaamo sr
wu rw
'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.
Value of Mechanical Work $.
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS (o Tub/Sb combo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS (Bath— Stk.)
_ EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
I SINKS
SUMPS
URINALS
VACUUM BREAKERS
r�
GAS LOGS
HOODS (com rcia11
RANGES
GAS WATER HEATERS
WATER CLOSETS Mlle)
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I certVy under penalty of perjury that the injbrmation 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 btformation supplied to the city as a part of
this application. �p
NAME/TITLE 1 0 L til.DATE Q I
(Signature) (17Ue) c
RELATIONSHIP TO PROJECT ❑ Owner /Agent ❑ Con ractor ❑ Architect ❑ Other
FOR OFFICE, USE ONLY
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES o NO
BASIC PLAN?
❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
❑ NO
NEW ADDRESS REQUIRED?
o YES o NO
IIP/SEPA/SU?
❑ YES
❑ NO
PLATTED LOT?
❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
o NO
Bulletin #100 —January 1, 2006 Page 2 of 4 k\Handouts\Permit Application