07-104540 CITY OF ( - _LV tts -T O
Federal Way RECEIVE •PERMIT SF .vIF CO ME EL PL DE ENO
COMMUNITY DEVELOPMENT SERVICES
33325 8TH AVENUE SOUTH•PO 11OX 9718 A P P L I C A T I O N
FEDERAL WAY,WA 98063-9718x.''.. 15 200 TD
253-835-2607•FAX 253-835-2607 r 1
uwrai.cituoffedervhuat,.com ��. -.- --_
i✓IT �The following is're% > s n-` n incomplete application will not be accepted. Please print legibly(in ink)or type.
,hr
�I/� 17,
, 0%PROPERTY INFORMATION
SITE ADDRESS_ /(1 V 3 1 i CLQ SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# —� 2,2-- '4 0- 00 ) LOT SIZE(sJ)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING , . FIRE PREVENTION SYSTEM
/
PROJ�CT D C IO (Provide ,l-'ailed de ription of work incl ded on thispermit onl
.601t �1 a i -5y6 • 4) 6( r A -iA/ s C
e4/ ) i / 77f,)'1 6p-out-mei 612+-e-4'
PROJECT NAME(Name of Business or Owner Last Name) /C.--!3e.8S
PEOPLE INFORMATION
PROPERTYNAME ,,,, PRIMARY PHONE
OWNER ( ) -
MA G ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
Are, p�� s - �e JY�O .
CONTRACTOR CO •'j •'j NA t /j/ / APPLICANT NAME OFFICE PH N
Mi,,,..,
, / ( i',' ,,/� Z�'3) 3 -3P/2
/%:A'1.4
SS 9006 w'.STATE,ZIP co 9 J tf / (E Is.Lki)N5?% - �I, t_—
ITY OF FEDERAL WAY BUSINESS LICENSE NUMBER dee.„.
EXPIRA•TTIIO'N_ ATE FAX NUMBER
'►' /00 -� '- /OCs"5/ -OO--- f, 4//o - ( ) -
ONTtRACTOR'S REGISTRATION NU ER EXPIRATJON DATE E-MAIL ADDRESS
COPY of card rogalred /00k
pr�r0 47 t 0
with each epplteatto //y/// ()wt.-APPLICANT C /�A�NN/Y NA �// APPLICANT NAME OFFICE H0)1 "pry
-1
eerrY
CELL PHONE
prgr"SS god,
I�IWAT/Y W1 �V• \ K/r/ CZ53) -1 P;z-
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect 0 Tenant 0 Agent 0 Other ( ) ?3 -(7 ST Z
PROJECT N PRI RY PHONJ�/� E-MAIL ADDRESS / _
CONTACT �� C1(�1 (�:a , 74.- 7,_,,v.,-9 2 �( t- is yofe.Al %✓co•C:6077
LENDER NAME •er RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS 4CITY,•STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE i i- USI._ ._�s.
EXISTING ASSESSED/APPRAISED VALUE$ %,� ALUE OF PROPOSED WORK $ 410'
SPRINKLERED BUILDING? 0 YES 0 NO ,.. SUPP• SSION SYSTEM PROPOSED '1 i"1 •i . .--i• • I" _.
i
WATER SERVICE PROVIDER ❑ LAKEHAVEN /❑ HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE \ PRIVATE(SEPTIC)
y)
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. . . SQ.FT. 1
BASEMENT 11 •
FIRST
SECOND \
THIRD \
ADDITIONAL FLOORS(DESCRIBE) \ / •
DECK(0 COVERED OR 0 UNCOVERED?) N ,,
GARAGE 0 CARPORT 0
•
NUMBER OF FLOORS LI°s""o PROPOssa TOTAL TOTAL LLQSTMO, TOTAL PROPOSED SP TOTAL SP
•
"'NEW HOMES ONLY** NUMBER OF BEDROOMS ' ESTIMATED SELLING PRI $
■ FIXTURES
Indicate number of each type of fixture to be installe• .r relocated as part of this project Do not include existing fixtures to remain.
•
MECHANICAL
Value of Mechanical Work$' (A COPY OF BID 0-, STIMATE MUST BE INCLUD WITH APPLICATION) I
. 1
AIR HANDLING UNITS EVAPORATIVE COOLERS\, GAS,'''.E OUTLETS WOODSTOVES
BBQS. FANS " S WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS % HOODS(commma.>)
COMPRESSORS FURNACESAllidhol. RANGES •
DUCTS GAS LOG SETSFRIG.SYSTEMS
•
PLUMBING
BATHTUBS torrob/shower combo) LAVS(Botbroo..,.''s) URINALS' MISC(Describe)
`
DISHWASHERS RAINWAT ` SYST VACUUM BRRS
DRINKING FOUNTAINS SHOW"'S WATER CLOSETS rro . ,
ELECTRIC WATER HEATERS SI, S WASHING MACHINES
HOSE BIBBS • MPS
SIGNATURE
I certify under penalty of perjury that the information 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 oft ty,including its officers and employees pon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE Aer 4 h1 /-417A- DATE . <5 v
i_' ret (TM
RELATIONSHIP TO PROJEC ❑ Owner ❑Agent 04.Contractor 0 Architect 0 Other
•
o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO . BASIC PLAN? • • o YES ANO
ZONING DESIGNATION CHANGE OF USE? . o YES o NO
NEW ADDRESS REQUIRED? . o YES a NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES o NO • DEMO PERMIT REQUIRED? a YES o NO
v
Bulletin#100—April 2,2007 . Page 2 of 4 k\Handouts\Permit Application