08-100947 CfroF �' RECE'�/E It g r
Federalll'Vay �ERMIT .2,117-
1
CO MMUNITY DR VELOPMENTSER VICES SF MF CO ME EL PL DE E FP
33325 8tH R SOUTH• BOX 9718 FEB 2 2 ��P L I C A T I O N
FEDERALL WAY,OWAU 98063-9718 TD
253-835-2607•FAX 253-835-2609 WAY�/
wwr:•dtuo�.:Ieralu nu.
, , OF FEDERAL WA 1
The following is required infonm544pn-an incomplete application will not be accepted. Please print legibly(in ink)or type.
_ - PROPERTY INFORMATION -
SITE ADDRESS,f /l a, L5 D LTi`. 2 e-i Lip i _ 7,t' j- 3 y SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 6 ,/ ? lid - QC 0 LOT SIZE(sj)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
I (Attach separate page for lengthy legal desorption)
1 ■ PROJECT INFORMATION .
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
)
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING CO FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
(-2( 1/6Q E' ) o ave-- Cd 0 E i. U L-- 3 6 a 1 fc.1 / 7A - c-t/c T- c-4ei-,,
® A su (.. s `/, 7-Eki,
i .
PROJECT NAME(Name of Business or Owner Last Name) 'f.4 r-'U F o a d S / /rh/6- -
al PEOPLE INFORMATION
•
' PROPERTYNA
;OLAS(-/k .
1 �( �o PRIMARY PHONE
OWNER (r1.V'e-k.�T IrYJ I)\' 6Q v� ( ) -MALINO ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
i ijCM6ss°„'') FAic cam/ - Gf-(-3-- T�/U,--7/,.sc y (��) ,,i, y/ - ?O / _
MAILI 0 ADDRESS CITY,STATE,ZIP CELL PHONE
U- ,Q _ JY 2Eh'SM 9 f poG) 6,s7) -606-7
CIT OF FEDERAL WAY BUSINESS UCENSE NUMBER EXPIRATION DATE FAX NUMBER
3 75'(64:1'31 -a 3�
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
-rlio r-10:' ” I C 6 2 c--?lr�")--,, ( U / — c) c/
APPLICANT COMPANY NAME APPLICANT NAME// OFFICE PHONE
�o(/-/ LS v", i / kt- ` C~6-11-- Tr7 d 1,1/fid e Ai (4-X) -) a 7/ -`�6 4
AILING ADDRESS CITY,STATE,ZIPCELL PHONE
P B, Bay cDc 3 a' 13),( "9-J ()64. ) 6 -6069
RELATIONSHIP TO PROJECT / FAX NUMBER
0 Architect 0 Tenant 0 Agent IN Other (9r) 39`f - //3
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT G --6'*•(mac 57- 777)o--7/is d ni (,- ) 6',fa - O r/ --o
LENDER NAME Per ROW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
•
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ /, 4.56- 6 0/ a
r
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES Cl NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
{ = - $ PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING PROPOSED TOTAL
SQ. FT. SQ. FT. SQ. FT.
BASEMENT
FIRST —
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS E7TETLfO PROPOSED TOTAL TOTAL=SUNG SF TOTAL PROPOSED sr TOTAL Sr
**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.
MECHANICAL
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 HO EiS(commercial)
COMPRESSORS FURNACES RANGES ~i
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower combo) LAVS(Bathroom sinkal URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(roues
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
• SIGNATURE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best of my
knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with all applicable
City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I 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 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 a part of this application.
)'SIGNATURE:A.\, DATE —e72.?- C)''Y
/ Property Owner and/or Authorized Agent
'11.4140)014 0.110,0tROMP:i.60410
a NEW a ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES o NO BASIC PLAN? o YES a NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? a YES o NO UP/SEPA/SU? o YES a NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES ❑NO
Bulletin#100—January I,2008 Page 2 of 4 k\Handouts\Permit Application