15-103219RACEPAD
ewer
JUL 06 A 0
FederalV"Y CITY OF FEDERAL 47
COMMUNTTV DEVELOPMENT SERVICES CXPPLICATION SF MF CO ME EL PL DE EN FP
33325 8TH SOUTH • PO 972 9718
FEDERAL WAY, WA 98063-9710
T53 -8.95-T607• FAX 253-835?609
www. rdaalr&Ieral wa u. corn
The following is required Worwtation - an incomplete application will not be accepted. Please print legibly (in inlc) or type.
SITE ADDRESS 30704 8th Ave SW gmrz/UNxT #
ASSESSOR'S TAR/PARCEL # 1788700315 _ _ _ _ _ _ _ LOT SIZE (sf)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(4n -h pWf r1. ,fid --Otto l
PROJECT. -
TYPE OF PERMIT id BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this Hermit onlu)
RESIDENTIAL REROOF. REPLACE 11 SQUARES OF COMPOSITE ROOFING. REPLACE 2 SHEETS OF PLYWOOD
NO STRUCTURAL CHANGES
PROJECT NAME (Name of Business or Oumer Last Name)
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
COSSIo
NAME
Ramon Cossio
PRIRY PHONE
( 253 ) 946-3937
MAILING ADDRESS
CITY, STATE, ZIP
E-MAIL ADDRESS
30704 8th Ave SW
Federal Way, WA 98023
CITY, STATE, ZIP
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
Home Depot At Home Services
CITY, STATE, ZIP
( 800 ) 381 - 5699
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
3600 LIND AVE SW STE150
RENTON WA 98057
_
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
20-03-101448-00-B
( ) -
CORTDAO'Pore !>f OISTMTI0N IIIJISEE6
XZPMATION DATZ
E-MAIL ADDRESS
HOMED"" 972RQ
02/03/2017
COMPANY NAME
Northwest Permit Inc.
APPLICANT NAME
Naida Khan
OFFICE PHONE
( 360 ) 945-2787
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
9808 31 ST AVE SE
EVERETT WA 98208
-
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant iZ Agent ❑ Other
( 888 ) 400-0383
NAME PRIMARY PHONE E-MAILADDRESS
Naida Khan/ Northwest Permit 360 945-2787 naida@nwpermit.com
NAME
Per R 19.27.095:
Lender igformatlon is required ifproject value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
/PHONE
l ) -
EXISTING USE Residential
EXISTING ASSESSED/APPRAISED VALUE
PROPOSED USE
VALUE OF PROPOSED WORK $ 6326.00
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE ISEPTICI
•
AREA DESCRIPTION
E3USTING
. FT.
PROPOSED
SQ. FT.
TOTAL
SQ. FT.
BASEMENT
CTAS WATER HEATERS MISC (Describe)
BOILERS
CEINSERTS
FIRST
COMPRESSORS
FURNACES
RANGES
SECOND
GAS LOG SETS
REFRIG. SYSTEMS
CHANGE OF USE?
THIRD
❑ NO
NEW ADDRESS REQUIRED? ❑
YES ❑ NO
ADDITIONAL FLOORS (DESCRIBE)
❑ YES
❑ NO
PLATTED LOT? ❑ YES ❑ NO
DECK (❑ COVERED OR ❑ UNCOVERED?)
❑ YES
❑ NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
�rnre
rsoro®�c
��
rnaroam
ar
"NEWHOMES ONLY"' NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type offixture to be installed or relocated as part of this project Do not include existing fvrtures to remain.
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
CTAS WATER HEATERS MISC (Describe)
BOILERS
CEINSERTS
HOODS (con s—isi)
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
PLUMBING
BATHTUBS (or Tub/Sho— Combo) LAVS (Bethroom sinks) URINALS MISC (Descn'be)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS [ro7et)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
I cartVy under penalty of perjury that I am the property owner or authorized agent of the property owner. I cartlfy that to the beat of my
knowledge, the information submitted in support of this permit application is true and correct. I cerWy 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 responsiNlity for compliance with local, state, or federal laws regulating construction or environnwntal lawn
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 cit36 including its ofjicars and employees, upon the accuracy of the information supplied to
the city as a part of this appiicatiopc*? A /j l
FJW,� 0)--14
dl��
FOR OFFICE USE ONLY
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑ YES ❑ NO
BASIC PLAN?
❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
❑ NO
NEW ADDRESS REQUIRED? ❑
YES ❑ NO
UP/SEPA/SU?
❑ YES
❑ NO
PLATTED LOT? ❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
Bulletin #100 — January 1, 2008 Page 2 of 4 kkHandouts\Permit Application