07-104463r .
Mm. A RECEAD _i O i (--� L�:) 3
Federal way PERMIT
COMMUNITY DEVELOPMENT SERVICES A U G 'APPLICATION SF MF' CO ME EL PL DE EN P�
33325 FEDERAL
A SOUTH• PO 63-971 9718 ��3pLI CATI ON
FEDERAL WAY, FAX
98063-9718
253-835-2607• FAX 253-895-2609 - - -
wwwAtuoffederalwau.com CITYOF F�ee0E�R�ADL WAY -
The following is rwubJihNll04t*� Tn incomplete application will not be accepted. Please Print legibly Cin ink) of type•
SITE ADDRESS % F 0 / -'50(i—IH
aVI H 3 2t ty i ®-� / SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # �O Z �t' C� - C/ LOT SIZE (sfi
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach sep—W.p seI r+-sUW k9wd—rirtoal
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING XFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed de iption of work included on this Permit oniu)
f/AJA/_ Ale3nk UP v 7TAA -PPA--Z) AOstjZ- (/18 36
t
PROJECT NAME (Name of Business or Owner Last Name) 6011 4 L5 s
PROPERTY
OWNER
CONTRACTOR
COP! at aero
with nc
• V
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
NAMEPRIMARY
6 C
-is -
PHONE
( ) -
MALLING ADDRESS
-177-1
CITY, STATE, ZIP
E -MAR. ADDRESS
COMPANY
AAA f1126,e 5A Ar i Y
APPLICANT NAME
APPLICANT NAME
SreorM).-'A
OFFICE PHONE
-177-1
MAILING ADDRESS
3o/3 3 RO 4(11.r N4,
MAILING ADDRESS
CITY, STATE, ZIP
S/_S/tmn 9S'10
CELL. PHONE
(ZZU) 2a2.
-7ZS
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
ZG -c'o -/v / 6 _ v - /c Z -3 (- o -7
FAX NUMBER
(zx3 )76'p
-ozF6
CONTRACTOR'S TION NU�M%BER -
EXPIRATION DATE
E-MAIL ADDRESSAAA
;T
COMP NAME
APPLICANT NAME
OFFICE PHONE
CITY, STATE, ZIP
PHONE
( )
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other
NAME S J � u/- : v r�6 1 2 � �, 3 YPHONE
z 0 z- 7 Z -5' � E_MALL ADDRESS
NAME
Per RCW 19.27.095:
Lender information is required (f project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
( )
EXISTING ASSESSED/APPRAISED VALUE $_
SPRINKLERED BUILDING? ❑ YES ❑ NO
PROPOSED USE
VALUE OF PROPOSED WORK $ /ll
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 BIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
-
EXISTING
80. FT.
PROPOSED
SQ. FT.
TOTAL
SQ. FT.
BASEMENT
(A COPY O BID OR ESTIMATE MUST BE INCLUDED WI7H APPLICATION)
BASIC PLAN?
o YES
FIRST
ZONING DESIGNATION
AIR HANDLING UNITS
EVAPORA. VE COOLERS
.SECOND
WOODSTOVES
BBQS .
FANS
THIRD
MISC (Describe)
BOILERS
FIREPLACE I SERTS
ADDITIONAL FLOORS (DESCRIBE)
IIEMO PERMIT REQUIRED?
COMPRESSORS
FURNACES
DECK -(0 COVERED OR 11 UNCOVERED?)
DUCTS
GAS LOG SETS
GARAGE O CARPORT O
NUMBER OF FLOORS
m3mo
rnorosso
TOTAL
TOTAL sr
voTAL P4orosso sr
u.
Torer
""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.
MECHANIC,,4L
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
Value of Mechanical Work $
(A COPY O BID OR ESTIMATE MUST BE INCLUDED WI7H APPLICATION)
BASIC PLAN?
o YES
n NO
ZONING DESIGNATION
AIR HANDLING UNITS
EVAPORA. VE COOLERS
GAS PE OUTLETS
WOODSTOVES
BBQS .
FANS
S WATER�HEATERS
MISC (Describe)
BOILERS
FIREPLACE I SERTS
HOODS (commerdal) .
IIEMO PERMIT REQUIRED?
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
PLUMBING
BATHTUBS rTub/shown combo)
LAV.S (sarm Si k.)
URINALS
MISC (Describe)
DISHWASHERS
RAIN TER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
OWERS
WATER CLOSETS (r.n q
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
I certify under penalty of perjury that the ir4/ormation furnished by me is true and correct to the best of -my knowledge, and further, that I
am authorized by the owner of .the above premises to perform the work for which the permit application is made. 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 of Federal Way, 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. j, ,
11
%/l/ S /�/�%/��� • DATE _ If
RELATIONSHIP TOIROJECT ❑ Owner ❑ Agent Acontractor ❑ Architect ❑ Other
D NEW o ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
o YES o NO .
BASIC PLAN?
o YES
n NO
ZONING DESIGNATION
CHANGE OF .USE?
o YES
o NO
NEW ADDRESS REQUIRED?
o YES o NO
UP/SEPA/SU?
o YES
o NO
PLATTED LOT?
o YES o NO
IIEMO PERMIT REQUIRED?
d YES
o NO
Bulletin #100— April 2, 2007. Page 2 of 4 k\HandoutslPermit Application