08-104388REQE16ED
PERMIT SF MF CO ME EL PL DE EN P
COiiAlt/MTYJ)B`EL0PMwS8Rvt 8s SEP 17
33325 BTM AV,iWA , WA 9 • JK/ 971 9718 �P�� AT I t3 �T
F1iDBRALWAY,WA 980G? -97J8 P� c[^1
253-835-2607- PAX sS3-s3s•Z6d9 m4MT_ V F F L D
The following is required wo" - an incomplete application will not be accepted. Please print legibbi (in ink) or type.
PROPERTY INFORIWATION
SITE ADDRESS "J.G .� "1 Nm e'j j �nu;e U- "m (,:; . SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # _ , _ _ _ ,_ _ ' — LOT SIZE (s f J
LEGAL DESCRIPTION (e.g. A me Estates, Lot 1)
PROJECT INFORMATION
PERUff ■ c«Mpro ■ PLUSONG ■ MECHANICAL
■ DEMOLMON ■ ELECTRICAL ■ ENGINEERING VLFM PREVENTION
PROJECT NAME (Name of Hess or Owner Last Name)
PROPERTY
PRIMARY PHONE
t � -
OWNER
C . STATE. ZIP
CONTRACTOR
FAX NUMBER
( -
0
APPLICANT
PROJECT
CONTACT
i 6 , 01bolow am
LENDER
RrA ,s
NAM
PRIMARY PHONE
t � -
MAILINO ADDRESS
C . STATE. ZIP
E-MAIL ADDRESS
COMPANY NAME APPLXANT NAME
OMCE PHONE
MAIIJNO ADDRESS CITY, STATE, ZIP
RELATIONSHIP TO PROJECT
o Architect o Tenant o Agent o Other
FAX NUMBER
( -
CELL PHONE
t• O - I ♦ 0012=4010M�.
i�r A ,I •
i 6 , 01bolow am
2 , ' �
RrA ,s
COMPANY NAME APPLXANT NAME
OMCE PHONE
MAIIJNO ADDRESS CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
o Architect o Tenant o Agent o Other
FAX NUMBER
( -
NAME
Per RCW 19.27 095.
Lender irtftrmation to required ffprvject value sxcseds $4000
MAILINO ADDRESS
CITY. STATE. ZIP
PHONE
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE VALUE OF PROPOSED WORK $Z.'15D.
BPRIrTKI.ERED BUILDING? o YES o NO FIRS, SUPPREMON SYSTEM PROPOSED/REQUIRED? o . YES o NO
WATER SERVICE PROVIDER n LA UMVEN o 111011LINE o TACOMA a PMATE (WELL)
SEWER SERVICE PROVIDER 13 LAKERAVEN 13 SIGHLINE a PRIVATE (SEPTIC)
sm
AREA DESCRIPTION
ElaSTINGF
SQ. FT.
PROPOSED
SO. FT.
TOTAL
SQ. FT.
BASEMENT
OAS WATER HEATERS MISC (Descn'be)
BOILERS'
FIREPLACE: INSERTS
FIRST
COMPRESSORS
— FURNACES
RANGES
SECOND'
GAS LOG SETS
REFRIG. SYSTEMS
a YES o NO
THIRD
o YES
a NO
PLATTED LOT?
ADDITIONAL FLOORS (DESCRIBE)
DEMO PERMIT REQUIRED?
o YES
a NO
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
ZUWMM
lROPOB1®
Toho.
ToruZXWMMu
ror"PRaeoeanar
rorecor
*"NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate. number of each type of fixture to be installed or relocated as part of this project. Do not include existing f ddures to remain.
d�CdIAIVTGIL
Value of Mechanical work $ (A COPY OF BID oR ESTIMATE MUST BE INCLUDED wrmAPPLICA71oh7
AIR HANDLING UNITS
EVAPORATIVE COOLERS
OAS PIPE OUTLETS WOODSTOVES
BBQS
FANS
OAS WATER HEATERS MISC (Descn'be)
BOILERS'
FIREPLACE: INSERTS
HOODS
COMPRESSORS
— FURNACES
RANGES
DUCTS.
GAS LOG SETS
REFRIG. SYSTEMS
BATHTUBS (-Tnb/ft .ercdomW
LAVS tea i.. aw
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS iromd
ELZOTRIC WATER HEATERS
SINKS
WASHING MACHINES.
HOSE BIBBS
SUMPS
NEW ADDRESS REQUIRED?
I ont(y under penaiig of poyary that I am the property owner or authorised agent of the property owner: I onto that to the best of mg
knowt+refs, the 6164rmabion submitted in supPort of this permit application is true and correct I eerlyy that I will oomph/ with all applicable
City qf )federal Way regulations pertaining to the work authorised by the issuance Rf a permit I understand that the issuance of this permit
does not remove the ownsex rrsponsibiHty for compliance with local, state, or foderal laser regulating construction or environmental lawn.
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 dofsnse of such claim), which may be made by any person, including the undersigned, and Jited against the city, but only
when such claim arises out of the reliance of the city, including its offleen and emplogoes, upon the accuracy of the igrormation supplied to
the city as apart of this application.
SIGNATURE:
22_71J,f '
o NEW o ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
- o YES o NO
BASIC PLAN?
a YES
a NO
ZONI G DESIGNATION
CHANGE OF USE?
a YES
a NO
NEW ADDRESS REQUIRED?
a YES o NO
UP/SEPA/SU?
o YES
a NO
PLATTED LOT?
o YES a NO
DEMO PERMIT REQUIRED?
o YES
a NO
Bulletin #100 —January 1, 2008 Page 2 of 4 MandoutsTermit Application