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06-105589T"'c,3- to Ned IWaylAe p06 PERMIT COMWOYLIEVEWPMEWSEMCEs SF�� MF CO ME EL PL DE EN FP -333258�AirLWAY,WA98POBOX 971��( $1 ��LICATION FEDEIL9LWAY, WA 98063-9718 1 253-835-2607• PAX 253-835-2609 Q wma C1tUo0ederoLuaU.rom FP e '( _.. P'1�• ��O (I is — an SITE ADDRESS 2U"+Y.� be accented. Please ASSESSOR'S TAX/PARCEL I LEGAL DESCRIPTION (e.g. Acrw Estates, Lot 1) (Attach a r—oA' Pr fw IetVft k_9Ld de—VdorV SUITE/UNIT # IAT SIZE (sf) i IN PROJECT INFORMATION �Ji' "" a / TYPE OF PERMIT BUILDING E4kq UMBING ;C *CHANICAL ❑ DEMOLITION "❑ ELECTRICAL. v❑ ENanvrWpstraG ❑FIRE PREVENTION SYSTEM PROJECT DESCRIPTION,(Proo(de detailed descript- - bLL�A' vft-?'� lfKls�r� %,rucFv-�-s CONTRACTOR CONTACT PEOPLE INFOR.M1'IATION NAME PRLMARY PHONE MAILING ADDRESS �: �. CITY. STATE, ZIP COMPANY NAME APPLICANT NAME OFFICE PHONE MARING ADDRESS CrIY, STATE, ZIP CELL PHONE MAHING ADDRESS CRY. STATE. ZIP CEM PHONE E ) MY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER B L CONTRACTORS REGISTRATION NUMBER (copy of card required with each application) EXPIRATION DATE / COMPANY NAME rl Nwt. AA APPLICANT NAME OFFICE PHONE MARING ADDRESS CrIY, STATE, ZIP CELL PHONE >tL?t-A'rrONSHIP TO PRDJECT Architect o Tenant D Agent ❑ Other .FAX NUMBER NAME t� PRIMARY PHONE E-MAIL ADDRESS jKIEAtLA Per RCW 39.27:©9S: Lender i LAxw stunt i5 NAME reQtdred Vprpject aalm meds $8,000 MAILING ADDRESS CITY, STATE, ZIP PHONE f ) - EXISTING USE 2�NEAI Q& PROPOSED USE ^r- U EXISTING ASSESSED/APPRAISED VALUE $ , OO,C! VALUE OF PROPOSED WORK $ )DCp SPRINHLERED BUILDING? ❑ YES )<NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? c YES Kim WATER SERVICE PROVIDER )KILAKEHAVEN ❑ .HIGM1NE ❑ TACOMA 0 PRIVATE (WELL) SEWER SERVICE PROVIDER c LASEHAVEN 0 HIGBLINE '—~ATE (SEPTIC) PROJECT FLOOR AREAS AREA DESCRIPTION EBISTING FT. PROPOSED SQ. FT. TOTAL SQ.FT. BASEMENT FIREPLACE INSERTS RANGES MISC (Describe) FIRST Boo 600 DUCTS l2- GAS PIPE OUTLETS ZONING DESIGNATION THIRD ❑ YES ❑ NO NEW ADDRESS REQUIRED? FOURTH SHOWERS I WATERCLOSE'TS pmlet) MISC (Describe) ADDITIONAL FLOORS (DESCRIBE) Z SINKS DRINKING FOUNTAINS ❑ YES DECK (COVERED?) X SUMPS RAINWATER SYST GARAGE ❑ CARPORT ❑ URINALS HOSE BIBBS NUMBER OF FLOORS VACUUM BREAKERS rrsoroa>m� TarwmsTnrc�� ' ror� **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. I Value of Medianicai Work AIR HANDLING UNITS EVAPORATIVE COOLERS _• GAS LOGS 3 REFRIG. SYSTEMS BBQS FANS HOODS )coum,excwj WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC (Describe) COMPRESSORS FURNACES GAS WATER HEATERS BASIC PLAN? DUCTS l2- GAS PIPE OUTLETS ZONING DESIGNATION G ❑ YES ❑ NO NEW ADDRESS REQUIRED? BATHTUBS t-i7.h/sb—combo) SHOWERS I WATERCLOSE'TS pmlet) MISC (Describe) DISHWASHERS Z SINKS DRINKING FOUNTAINS ❑ YES GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS (Bathroom antis) VACUUM BREAKERS ELECTRIC WATER HEATERS I certify wider penalty of perjury that the information furnished by me is true and correct to the best of mg 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 tinchuiing 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. r7 DATE (Signature) TO O.TF•CT ❑ Owner ❑ Agent ❑ Contractor 'd Architect ❑ Other FOR. OFFICE USE ONLY o NEW ❑ ADDITION o ALTERATION ❑ REPAIR o TENANT iMP3iOVEMENT BUILDING SHELL ONLY? ❑ YES ❑ NO BASIC PLAN? ❑ YES o NO ZONING DESIGNATION CHANGE OF USE? ❑ YES ❑ NO NEW ADDRESS REQUIRED? ❑ YES ❑ NO UP/SEPA/SU? n YES Q NO PLATTED LOT? a YES ❑ NO DEMO PERAHT REQUIRED? ❑ YES tI NO Bulletin #100 — January 1, 2006 Page 2 of 4 k1Han 1 utsslou APermit Application " ;ro FA Site Plan impervious Surface 2,3115E NEW ACU � GAZEBO 5779 5F=XiSTING "RIMARY DUELLING 3,968 fiF EXISTING GRAVEL DRIVEWAY 11950 � TOTAL PROPOSED IMPERVIa15 9Uf&AGE 2789 SF EXISTING CABINS 5779 SF EXISTING PRIMARY DWELLING 3,960 SF EXISTING GRAVEL DRIVEWAY 11528 ^� EXISTING MPERVIOUS SURFACE 1194E SF ADDED IMPERVIOUS SURFACE 1II OF PROPOSED IMPERVIOUS 5UR-AGE 159,4256F S1TE AREA T1%IMPERVIOUS SU -ACS 4 v FUGET 6OLNE) 14h- 14+® 15 I Partial Site Plan 4tSU�°" I .E I J YLD'� s - E iyNN (G'0 M A100 0518 D2lL8/08 W m 1 c G r 3