08-102006Cln•F CEIV
Federal
PERMIT' 1 SF MF CO ME -L DE EN FP
. 33325-8-
5 1y E°��,WA9 SER 2 5 Zoos APPLICATION
.FEDERAL WAY, WA 98063-9718 To
253-835.2607• FAX 253.835-2609
NMI ". F FEDERAL WAY
The following is requi>tTj),gbrmation -an incomplete application will not be accepted. Please print legibly (in ink) or. type.
SITE ADDRESS `�2 LQeLV l
ASSESSOR'S TAX/PARCEL #
LEGAL DESCRIPTION (e.g. Acme Estates, Lot I)
SUITE/UNIT #
LOT: SIZE (s])
/Attach .P - .t. Page fw I -WOW legal dwaip6.W .
PROJECT• •
TYPE OF PERMIT ❑ BUILDING O PLUMBING O MECHANICAL
❑ DEMOLITION ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed descriptionof ork included on this permit onlul
j�leu� 3ol�rse 200 fir(
PROJECT NAME (Name of Business or Owner Last Name)
PEOPLE• •
PROPERTY
OWNER
C CTOR�
�1 V
COPY o card r gaind
with each nppH—tion
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
NAME PRIMARY PHONE
MA]LING ADDRESS �. .jTSTATE,
c,� ZI� ��� � vl E-MAIiA�pR��
PA 1 • J J !ZJ
MPANY NAME
APPLICANT NAME
A PLICANT NAME
OFFICE PHONE
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other
FAX NUMBER
AI jVU DDRE,46
PRIMARY PHONE
(2 3 70-- 121
CITY, STATE, ZIP
K
CELL PHONE
-
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
XPI RAT OND TE
FAX NUMBER
jq
-04-
12 31 dT
(15V 5? I
-i07'7
CONTRACTOR'S REGISTRATION NUMBER
EXPIRA ION DATE
E-MAIL ADDRESS
U
C��ilM1
Irl
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other
FAX NUMBER
NAME
lob NuAi&d
PRIMARY PHONE
(2 3 70-- 121
E-MAIL ADDRESS
NAME
Per RCW 19.27.095:
Lender information is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING ASSESSED/APPRAISED VALUE
PROPOSED USE
VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE D TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ PRIVATE (SEPTIC)
. COPS
AREA DESC ION
EXISTING
SQ _
PROPOSED
SQ. FT.
TOTAL
SQ. PT.
BASEMENT
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
FIRST
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS (foile4
SECOND
SINKS
WASHING MACHINES
HOSE BIBS
THIRD�
o YES
a NO
pT.ATTRD LOT?
ADDITIONAL FLOORS (DESC E)
DEMO PERMIT REQUIRED?
o YES
o NO
DECK (O COVERED OR ❑ UNCO D7)
GARAGE 0 CARPORT ❑ .
NUMBER OF FLOORS
mpgp]110
OPOSED
TOTAL
TOTAL ZXMTJNO Sr
7.OT PROPOSED S7
TOTAL ST
•"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED ESTIMATED SELLING P CE $
Indicate number of each type of f�zture to be installed or relocatec�gs part of tY,kis project. Do not include existing futures to remain
Value of Mechanical Work
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DI CTS
(A COPY OF BID -OR
EVAPORATIVE
FANS
FIREPLACE IN
FURNACES
``i
GAS LOG )SETS
BE INCLUDED WITH APPLICATION)
AS PIPE OUTLETS WOODSTOVES
G WATER HEATERS MISC (Describe)
HOO (Commerdan
RANGES '
REFRIG.SYS S
PLUMBING
o ALTERATION
o REPAIR o TENANT IMPROVEMENT.
BATHTUBS (or Tub/Sh—Climbo)
LAYS (Bathroom Sinks)
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS (foile4
ELECTRIC WATER HEATERS"'
SINKS
WASHING MACHINES
HOSE BIBS
SUMPS
o YES
I certify under.penalty of perfury 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 of the city, including its officers and employees, upon the accuracy of the information supplied to the city as a part of
this application.
DATE 14NAME/TITLE k�
iftnature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent Contractor ❑ Architect ❑ Other
o NEW o ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT.
BUILDING SHELL ONLY?
o YES o NO
BASIC PLAN?
a YES
ONO
ZONING DESIGNATION
CHANGE OF USE?
o YES
ONO
NEW ADDRESS REQUIRED?
o YES o NO
UP/SEPA/SU?
o YES
a NO
pT.ATTRD LOT?
o YES o NO
DEMO PERMIT REQUIRED?
o YES
o NO
Bulletin #100—January I; 2007 Page 2 of k\} andouts\Permit Application .