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COMMUNITY D8V8GOPMW SBRVX:BS
333258 AVENUE SOUTH • FO BOX 9718 0E(- 2 9AP P LI C AT I O N
F8D8RA4 WAY,, WAA.98063.9718
253438.2607• PAX 253-835-2609
.om CITY OF FEDERAL W y
The following is required rq~'orte"n - an complete application will not be accepted. Please print legObj (in ink) or type-
PROPERTY
INFORAIATION
SITE ADDRESS _32% ll i ha- U--�re1C 'SSUITE/UNIT #
ASSESSOR'S TAX/PARCEL #
LEGAL r' •
PROJECT INFORMATION
LOT SIZE (s, fJ
TYPE OF PERMIT O BUILDING O PLUMBING ❑ MECIIANICAL
O DEMOLITION O ELECTRICAL O ENGINEERING ,FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work mduded on this nerinit o_W
A6& C.3:&) -�ny--e- %11-rA
iM
N PEOPLE INFORIIIATION
APPLICANT
A�
COMPANY NAM
APPLICANT NAME
OFFFIICE PHONE
CITY. STATE, ZIP
PHONE
MAILING ADDRESS
crry, STATE, ZIP
LINO
CITY, STATE, 21P
CELL PHONE
0 Architect a Tenant 4 Agent o Other C0rriYyz*)r
( -
Mill Cr
-
O��Fry/FEDERAL W}}AB�Y BUSIAiE331,10INSE NUMBER EXPIRATION DATE
FAX NUMBER
+f
CONTRACTOR'S REOIBTRATION NUMBER.. SXPZRATIOH DATE
E-MAIL ADDRESS
1 1 S
raw
cwPANY HAMS
APPL3CANT NAME
OFFICE PHONE
CITY. STATE, ZIP
PHONE
MAILING ADDRESS
crry, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
0 Architect a Tenant 4 Agent o Other C0rriYyz*)r
( -
'0"
PROJECT NAMEPRIMARY PHONE E 'ADDRESS
CONTACT CA - Z t' h ptyt
LENDER
NAME Per RCW 19.27.095
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK S 3, -500, Wy
SPRiNICLERED BUILDING? a YES o NO FIRE SUPPRESSION SYSTEM[ PROPOSED/REQUIRED? o YES a NO
WATER SERVICE PROVIDER D LAKEIIAVEN o MGWMM a TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER O LAKERAVEN a HIGHLINE 13 PRIVATE (SEPTIC(
:
Leruter ft&rmaclon is roquired #fpr jea ealuo axe**& 05,000
MAHMO ADDRESS
CITY. STATE, ZIP
PHONE
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK S 3, -500, Wy
SPRiNICLERED BUILDING? a YES o NO FIRE SUPPRESSION SYSTEM[ PROPOSED/REQUIRED? o YES a NO
WATER SERVICE PROVIDER D LAKEIIAVEN o MGWMM a TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER O LAKERAVEN a HIGHLINE 13 PRIVATE (SEPTIC(
AREA DESCRIPTION
EXISTING
. FT.
PROPOSED
So. FT.
TOTAL
SO. FT.
BASEMENT
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS PIPE OUTLETS WOODSTOVES
FIRST
FANS
GAS WATER HEATERS MISC (Describe)
BOILERS`
"SECOND -
HOODS (commdrda$
COMPRESSORS
FURNACES
THIRD
DUCTS.
GAS LOG SETS
REFRIG. SYSTEMS
ADDITIONAL FLOORS (DESCRIBE)
DEMO PERMIT REQUIRED?
a YES
o NO
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
O
PRQPO6tD
TWAL
MAL RXISIM OF
MAL reawossoar
Tor"ar
"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 fudures to remain.
113(29AHICAL
LAYS (s"tbm"mswo
DISHWASHERS
Value of Mechanical Work $
fA COPY OF BID OR ESTIMATE MUSE BE INCLUDED WITHAPPLICATIOM
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS PIPE OUTLETS WOODSTOVES
BBQS
FANS
GAS WATER HEATERS MISC (Describe)
BOILERS`
FIREPLACE INSERTS
HOODS (commdrda$
COMPRESSORS
FURNACES
RANGES
DUCTS.
GAS LOG SETS
REFRIG. SYSTEMS
-BATHTUBS f-TUb/31mm•Camb4
LAYS (s"tbm"mswo
DISHWASHERS
RAINWATER SYST
DRINKING FOUNTAINS
SHOWERS
_ ELI=PJC WATER HEATERS
SINKS
HOSE BIBBS
SUMPS
URINALS MISC (Describe)
VACUUM BREAKERS.
WATER CLOSETS Iroikq
WASHING MACHINES,.
I certV# under penalty of perjury that I am the property owner or authorized agent of the prop" owner. I certify that to the best q f my
knowlsdi% the bV'brmation submitted in support of this permit applicatton is true and can-oct I cw tUk that I will eompty with all applicable
City gf Federal Way regulations pertaining to the work authorised bg the issuance of a permit. t 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 mag be mads by any person, including the undersigned, and filed against the city, but only
where such claim arises out of the reliance nce of the city, including its qfflcsrs and employees, upon the accuracy of the Wormation supplied to
the city as apart of this application.
o NEW o ADDITION
a ALTERATION
o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
o YES o NO
BASIC PLAN?;
o YES
a NO >
ZONING DESIGNATION
CHANGE OF USE?
a YES
a NO
NEW ADDRESS REQUIRED?
o YES a NO
UP/SEPA/SU?
o YES
a NO
PLATTED LOT?
a YES a NO
DEMO PERMIT REQUIRED?
a YES
o NO
Bulletin #100 — January 1, 2008 Page 2 of 4 k\HandoutsTermit Application