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The following is required information - an incomplete application will not be accepted. Please print legibly (in ink) or type.
SITE ADDRESS WOW SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # LOT SIZE (qj)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Aft.M P—t. P-" 1 I-Vft bod 'U—rd-4
PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING AFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide de i of work inctudql on this Permit oW
29) &ads
PROJECT NAME (Name of Business or Owner Last Swim)
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
NAME PRIMARY PHONE
Ea5k
MAILING ADDRESS CITY, STATE,7 P E-MAIL ADD
,I
OMPANY NAME
APPLICANT NAME
OFFICE PHONE
NO DDRESS-
-CITY, ST E ZIP
Ell PHONE
I Izi L2
Z&Q
MAILING ADDRESS
vo ?-lox
-CITY, STATE, ZIP
112-M22 W A\ Cx-&& LL'A
CELL PHONE
nYr-1
a Architect a Tenant 0 Agent / Other \-VY-11LC*Q
CITY-OFIPEDERAL
WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
PAX NUMBER
CONTRA OR'® REGISTRATION
NUMBER EXPIRATION DATE
FMAIL ADDRESS
cgum�lr-
Mu-' 14-9-02
1 ►icaE-Crounfk
MPANY NAME
PPLICANT NAME
OFFICE PHONE
NO DDRESS-
-CITY, ST E ZIP
Ell PHONE
I Izi L2
-
R T_
S IONSHIP To PROJECT
FAX NUMBER
nYr-1
a Architect a Tenant 0 Agent / Other \-VY-11LC*Q
qZS-) 49) -
I NAME PRIMARY PHONE C"-MAILADDRESS nE;kve, 1 M-5) qffl - ZL-0 Babde-apLonfp-t
NAME
PerRCW19.27.095.
Lender Wormation is required ifproject value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE •---VALUE OF PROPOSED WORK $,
SPRINKLERED BUILDING? Y YES o No FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? yd / YES 0 NO
WATER SERVICE PROVIDER a LAREHAVEN a IIIGHLINE o TACOMA 0 PRIVATE (WELL)
SEWER SERVICE PROVIDER o LAKEHAVEN [I HIGHLINE o PRIVATE (SEPTIC)
M
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
s . FT.
BASEMENT
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
FIRST
COMPRESSORS
FURNACES
RANGES
SECOND
GAS LOG SETS
REFRIG. SYSTEMS
o YES a NO
THIRD
o YES
a NO
PLATTED LOT?
ADDITIONAL FLOORS (DESCRIBE)
DEMO PERMIT REQUIRED?
a YES
o NO
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
suseaa
FROrOesO
tore.
TOTAL ERINIM el
TOTAL JWGPOMOor
- TOTAL er
-NEW HOMES ONLY'" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
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 $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS PIPE OUTLETS WOODSTOVES
BBQS
FANS
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
HOODS pommeni q
COMPRESSORS
FURNACES
RANGES
DUCTS.
GAS LOG SETS
REFRIG. SYSTEMS
BATHTUBS (w Tub/Shower Combe) LAVS (Bathroom sh*o
DISHWASHERS RAINWATER SYST
DRINKING FOUNTAINS SHOWERS
ELECTRIC WATER HEATERS SINKS
HOSE BIBBS SUMPS
URINALS MISC (Describe)
VACUUM BREAKERS
WATER CLOSETS (ToBeq
WASHING MACHINES .
I certVy under penalty of perjury that t am the property owner or authorised agent o/ the property owner. I certVy that to the best of my
knowledge, the information submitted in support of this permit application is true and correct I certuk that I will comply with all applicable
City of Federal Way regulations pertaining to the work authorised by the issuance o% a permit. I understand that the issuance of this permit
doss 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 attornegs' 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 tib C pplication.
SIGNATURE:
a NEW a ADDITION
a ALTERATION
a REPAIR o. TENANT IMPROVEMENT
BUILDING SHELL ONLY?
a YES o NO
BASIC PLAN?
a.YES
a NO
ZONING DESIGNATION
CHANGE OF USE?
a YES
n NO
NEW ADDRESS REQUIRED?
o YES a NO
UP/SEPA/SU?
o YES
a NO
PLATTED LOT?
a YES o NO
DEMO PERMIT REQUIRED?
a YES
o NO
Bulletin #100 — January 1, 2008 Page 2 of 4 MHandout0ermit Application