08-1042734
REOVIVE
deralWay PERMIT
COMMUNITYDEVELOPMENT SERVICES SEP SF MF CO ME EL PL DE EN
33335 8w AVENUE SOUTH - PO BOX 9718 P��
FEDERAL WAY, WA 98063-9718 LI 1 I O N
353.835-3607• FAX 3S3-835-3609 LA ,Q� 1 1 \[D
/
.a<�mru.�m CITY OF FEDERAL W Y
The following is required fqfbrmatGDSn incomplete application will not be accepted. Please print legibly (in ink) or type.
ASSESSOR'S TAX/PARCEL #
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
■ PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
LOT SIZE (sj
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING AFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detaile4 description of work included on this permit onlu)
PROJECT NAME (Name of Business or Owner Last Name)
PEOPLE•• •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
NAME F
LLC—
PRIMARY PHONE
MAILING ADDRESS I CITY, STATE, ZIP
ri�G Six' S.
E-MAIL ADDRESS
COMPANY NAME
Y2IIJA
APPLICANT NAME
MAILING ADDRESS
OFFICE PHONE
PHONE
MAILING ADDRESS
CITY STATE, ZIP
'lp .
tt '' ,,
Wk
CELL HONE
-
C OF FEDERAL WAY BUSINESS LICENSE NUMBER
$• S L
EXPIRATION
DATE
FAX NUMBER
( ) -
CONTPACTOR'ff REGISTRATION NUMBER
EXPUUTION
DATE
E-MAIL ADDRESS
COMPANY NAME
cisco n
APPLICANT NAME
OFFICE PHONE
( ) -
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other
FAX NUMBER
NAME PRIMARY PHONE - E-MAIL DRESS
NAME
Per RCW 19.27.095.
Lender igformation is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK * 1 19M CD
SPRINKLERED BUILDING? RS YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? /YES o NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
i.-pgr\
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
SQ. FT.
BASEMENT
SHOWERS
ELECTRIC WATER HEATERS
SINKS
FIRST
SUMPS
CHANGE OF USE?.
SECOND
o NO
NEW ADDRESS REQUIRED?
o YES a NO
THIRD
o YES
a NO
PLATTED LOT?
ADDITIONAL FLOORS (DESCRIBE)
DEMO PERMIT REQUIRED?
o YES
a NO
DECK (O COVERED OR O UNCOVERED?)
GARAGE O CARPORT O
NUMBER OF FLOORS
awsesra
rxoroeao
toter
rorty==mesr
tomersoroesoor
rormsr
"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 fixtures to remain.
Value of Mechanical Work $ (ACOP OF BID OR ESTIMATE MUST BE INCLUDED W1TH APPLICATION)
AIR HANDLING UMTS EVAPORATIVE COOLERS
BBQS FANS
BOILERS FIREPLACE INSERTS
COMPRESSORS FURNACES
DUCTS. GAS LOG SETS
BATHTUBS (or Mb/Shower Combo)
I.AVS (Bathroom side
DISHWASHERS
RAINWATER SYST
DRINKING FOUNTAINS
SHOWERS
ELECTRIC WATER HEATERS
SINKS
HOSE BIBBS
SUMPS
GAS PIPE OUTLETS WOODSTOVES
GAS WATER HEATERS MISC (Describe)
HOODS (Cemoutdq
RANGES
REFRIG. SYSTEMS
URINALS MISC (Describe)
VACUUM BREAKERS
WATER CLOSETS poiteq
WASHING MACHINES
I certify under penalty of peyury that I am the property owner or authorised agent of the property owner. -I certW that to the best of my
knowledge, the Wormation submitted in support of this permit application is true and correct I cer ft that l will comply with all applicable
City of !Federal Way regulations pertaining to the work authorised by the issuance of a permit I understand that the issuance of this permit
dJ., not remove the ownses rosponsibility for compliance with local, state, or federal laws regulating construction or environmental laws.
I further agree to hold harmless the City of Irederai 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 apart of this application.
SIGNATURE.
Authorized
a NEW a ADDITION
a ALTERATION
o REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY?
a YES a NO
BASIC PLAN?
o YES
o NO
ZONING DESIGNATION
CHANGE OF USE?.
a TES
o NO
NEW ADDRESS REQUIRED?
o YES a NO
UP/SEPA/SU?
o YES
a NO
PLATTED LOT?
o YES a NO
DEMO PERMIT REQUIRED?
o YES
a NO
Bulletin #IOO — January 1, 2008 Page 2 of 4 WiandoutsTermit Application