06-100434Federal way
a 2006 rE� I
COMMUMT AVENUE
S O 171 - P SER
3332E D RAEWA .WA 9.639718-ICATION.
FEDERAL WAY. WA 98063-9718
as3-835-2607- FAX 253-835-2W9CITY OF FED
LL.LLLL"f"w`re&ra&wu.wm BUILDING DEPT.
The followina is reautred information - an incomplete application will not be
SITE ADDRESS (� �%
ASSESSOR'S TAX/PARCEL # C 1 j—v - La. _1.J —0
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)C
1 _ -Doq-3-q
kF CO ME EL PL DE EN FP
Please
SUITE/UNIT M
LOT SIZE (sfl
or
PROJECT
TYPE OF PERMIT )KBUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM ^
PROJECT DESCRIPTION (Provide detailed discr� tion of work included on is f< on
>� A/ln 0 a 0 Pal;,
Ii (14/YY11 jL[.,) —
PROPERTY PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
of Business d► Owne?Tost Name)
MAILING ADDRESS aini •r
0A Q <�Y V O! 1 l
COMPANY NAME _ NAME OFFICE PHONE
/—f o P 5 c yam y-
I�JG ADD ny. S . Z CELL PHONE
(ool. ► � WA c ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
CONTRACTORS REGISTRAM014 NUMBER (espy bt earl required with each a*Bcatisu) EXPIRATION DATE
L- Lsc .[7t.9sy 0-7 // /07
C MPANY NAME �-
1C T N
(O{F�FICE PHO _ y
0/1
LaQ
\� l/ ��
-
MArfADD
C T ZIP
CELL PHONE
Irl
I (x
V
RELATIONSHIP TO PROJECT
Other (Describe)
FAX NUMBER J
�r� y
❑ Architect ❑ Tenant Agent ❑
EXISTING USE
EXISTING ASSESSED/APPRAISED VALUE $_
SPRINKLERED BUILDING? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN
SEWER SERVICE PROVIDER 0 LAKEHAVEN
PROPOSED USE
VALUE OF PROPOSED WORK $
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES
o HIGHLUM ❑ TACOMA ❑ PRIVATE (WELL)
❑ HIGHLINE ❑ PRIVATE (SEPTIC)
❑ NO
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
S9. FT.
BASEMENT
FANS
HOODS (coo,meraai)
WOODSTOVES
FIRST
_AC—ri,
❑ YES ❑ NO
BASIC PLAN?
SECOND
FIREPLACE INSERTS
g
MISC (Describe)
THIRD
FURNACES
GAS WATER HEATERS
NEW ADDRESS REQUIRED?
FOURTH
GAS PIPE OUTLETS
❑ YES
o NO
ADDITIONAL FLOORS (DESCRIBE)
o YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
DECK (COVERED?
GARAGE CARPOrct u
'
WATER CLOSETS ribilet)
OF FLOORS
aXMTnW
TOTALa�,n o OF
r®oraem v
corer, WNUMBER
••NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
DRINKING FOUNTAINS
PI
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 l
Value of Mechanical Work $
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS LOGS
REFRIG. SYSTEMS
BBQS
FANS
HOODS (coo,meraai)
WOODSTOVES
_AC—ri,
❑ YES ❑ NO
BASIC PLAN?
BOILERS
FIREPLACE INSERTS
RANGES
MISC (Describe)
COMPRESSORS
FURNACES
GAS WATER HEATERS
NEW ADDRESS REQUIRED?
DUCTS
GAS PIPE OUTLETS
❑ YES
o NO
G
o YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
BATHTUBS (or Tub/shower combo)
SHOWERS
WATER CLOSETS ribilet)
MISC (Describe)
DISHWASHERS
SINKS
DRINKING FOUNTAINS
GAS PIPE OUTLETS
SUMPSRAINWATER
SYST
WASHING MACHINES
URINALS
HOSE BIBBS
LAVS (Mhroom Sinks)
VACUUM BREAKERS
ELECTRIC WATER HEATERS
I certVy 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, andjiled 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 irlformation supplied to the city as a part of
this application.
cS
NAME/TITLE / 4�� DATE �!
(Signatur (Ilde)
RELATIONSHIP TO PROJECT Vovmer XAgent Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
o NEW o ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES ❑ NO
BASIC PLAN?
❑ YES
o NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
o NO
NEW ADDRESS REQUIRED?
❑ YES ❑ NO
UP/SEPA/SU?
❑ YES
o NO
PLATTED LOT?
o YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
Bulletin #100 —January 1, 2006 Page 2 of 4 Mandouts\Permit Application