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FbderalWay
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939158EMiWY,WA9•PO> 971 f(gy gRLICATION
FBDERA6 WAY, WA 98063-9714 � �• ° o /
?S9-8351607• PAX 153-0351609
w�atu. d�Jederohuny. cmn
GAN Qtr nn�NG pE?T.
The following is require 'ation - an incomplete application will not be accepted Please print_legibly (in ink) or type.
PROPERTY•• •
SITE ADDRESS _ ' RX -9-Z%
ASSESSOR'S TAX/PARCEL #
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
■ PROJECT INFOMIATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING. ❑ MECHANICAL
SUITE/UNIT #
LOT SIZE (si
❑ DEMOLITION ❑ ELECTRICAL O ENGINEERING JKFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
'in:54 )i KaA�,I�^v � rr' 5. !�(x Pre rt ;J? C_f/ �� ��t oGe)
PROJECT -NAME (Name of Business or Owner Last Nam el `I aLLLz1/ logw
PEOPLE,•• •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
NAME
pile
PRIMARY PHONE
MAILING ADDRFS
CITY, A E. ZI
E-MAIL ADDRESS
o
�—
�-
COMPANY NAME
APPLICANT NAME
APPLICANT NAME
MAI 40 DRESS
OFFICE PHONE
o
�—
ra� k
(2o6 ) 2 2 � 2 Y5
MAILING DRES
3 Lc.�
I
CrPf. STATE, ZIP
�'
C LL PHONE
T -I C_
�
gkli
Z
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBS
CONTRACTOR'e REGISTRATION NUMBER
XIFIRATI
S -MAIL ADDRESS
,ONGDATE
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAI 40 DRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other
FAX NUMBER
NAME PRIMARY PHONE &MAIL ADDRESS
Z
NAME
Per RCIV 19.27.095: -
Lender information is required (/project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK
SPRINKLERED BUILDING? O YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 4 -YES ❑ NO
VfATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE ISEPTICI
PROJECT ••• AREAS
AREA DESC N ERISTING
SQ. FT.
BASEMENT
PROPOSED
50. FT.
TOTAL
S . FT.
RSA
BUILDING SHELL ONLY?
o YES. o NO
BASIC PLAN?
SECOND
o NO
ZONING DESIGNATION
THIRD .
o YES
o NO
NEW ADDRESS REQUIRED?
ADDITIONAL FLOORS (DESCRIBE)
UP/SEPA/SU?
o YES
o NO
DECK (0 COVERED OR O UNCOVERED?)
o YES o NO
DEMO PERMIT REQUIRED?
G YES
GARAGE 0 CARPORT O
NUMBER OF FLOORS
aQ'raO
ntO*O°L°
TOTAL
TWAcsasrawsr
r°r" Mopo n•r
zonae
"NEW HOAM 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 furtures to remain.
Value of Mechanical Work $ (A COPY OF BIDOR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
PLUJOW0 "
BATHTUBS (or Tub/Shower combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS LOG SETS .
LAVS (s■eh,nom stoke)
RAINWATER SYST
SHOWERS
SINKS
SUMPS
GAS PIPE OUTLETS
GAS WATER HEATERS
HOODS )Commerotap
RANGES
REFRIG. SYSTEMS
URINALS
VACUUM BREAKERS
WATER CLOSETS trat q
WASHING MACHINES
WOODSTOVES
MISC (Describe)
MISC (Describe)
I cwWy under penalty of perjury that ! am the property owner or authorised agent of the property owner. I cenft that to the best of my
knowledge, the t4ormation submitted in support of this permit application is true and correct I cert(fjt that I will comply with all applicable
City of Federal Way regulations pertaining to the work authorised 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.
1 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 flied 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 apart of this application. A
SIGNATURE:
PJ
o NEW o ADDITION
a ALTERATION
a REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
o YES. o NO
BASIC PLAN?
o YES
o NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
o NO
NEW ADDRESS REQUIRED?
a YES o NO
UP/SEPA/SU?
o YES
o NO
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED?
G YES
o NO
Bulletin #100 _ August 16, 2007 Page 2 of 4 . k\Handouts\Permit Application