11-1006740
aw OPERMIT
Federal Way MF CO ME PL DE EN FP
COMMUNITY DEVELOPMENT SERVICES
253-835-2607• FAX 253-835-2609
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APPLICATION
SITE ADDRESS
SUITE/UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
TYPE OF PERMIT
XBUILDING X PLUMBING X MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeoumer Last Name)
PROJECT DESCRIPTION
New Construction - Single Family Residence
Detailed description of work to
2`
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
V-
SSHI LLC dba D.R. Horton
425 821-3400
S126th
E-MAIL
q;�
12931 NEDIG
Place
CITY
Kirkland
STATE
WA
ZIP
98034
0�1
NAME
Same as 12ropegy owner
PHONE
MAILING ADDRESS
E-MAIL
��1V`I'RA�OR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
DRHOR**963CS
08 03 12
20 -10 -101914 -00 -BL
NAME
PHONE
Same as owner and contractor
APPLICANT
MAILING ADDRESS
E-MAII
CITY
STATE
ZIP
FAX
PROJECT CONTACT
(The individual to receive and.
NAME
Christine Brown
PHONE
(425) 821-3400 x5135
MAILING ADDRESS
E -MAH,
crbrown@drhorton.com
respond to all correspondence
concerning this application)
CITY
STATE
ZIP
FAX
(817) 928-2067
ALTERNATE CONTACT NAME:
PHONE
E-MAIL
PROJECT FINANCING
Required value of $5,000 or more
NAME
SSHI owns the lots - No lender
OWNER -FINANCED
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify 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 of this application.
SIGNATURE:}rDATE 2 I (lG 1
PRINT NAME: Christine Brown
Bulletin #100 - January 1, 2011 Page 1 of 3 k:\Handouts\Permit Application
PLAN 3720
VALUE OF MECHANICAL WORK $ `7, 9 b b (a copy of bid or estimate must be provided)
Indicate how many of each type of facture to be installed or relocated as part of this project. Do not include existing fuctures to remain.
AIR HANDLING UNITS FANS -' GAS PIPE OUTLETS OTHER (Describe)
-- AIR CONDITIONER 1 FIREPLACE INSERTS HOODS (Commemiai)
-- BOILERS 1 FURNACES 1 HOT WATER TANKS (Ges)
-- COMPRESSORS -- GAS LOG SETS -- REFRIGERATION SYST
-- DUCTING 4 GAS PIPING -- WOODSTOVES
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
2
BATHTUBS (or Tub/Shower Combo)
4
LAVS (nand Sinks)
3 TOILETS
1 WATER PIPING
1
DISHWASHERS
--
RAINWATER SYSTEMS
-- URINALS
OTHER (Describe)
--
DRAINS
2
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
2
SINKS ([suchen/Utility)
-' WATER HEATERS (Eiectric)
2
HOSE BIBBS
-'
SUMPS
1 WASHING MACHINES
18 TOTAL FIXTURES
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
Lakehaven Utility Lakehaven Utility $
EXISTING/PREVIOUS USE LOT SIZE (In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes X No ❑ Yes X No
Bulletin #100 -January 1, 2011 Page 2 of 3 k:\Handouts\Pennit Application