07-102733�. RECEM®
Federal Way PERMIT
COMMUNITY DEVELOPMENT SERVICES MAY 1.. S 2007
PERMIT
3332AVENUE SOUTH • BOX 97]8
EEDERAL WAY, 98063 V
I Cam T I O N
253-83x2607• FAX 253-835-2609 CITY 0� FG A
i_±u_. ciklnlledera.uxi°. egm BUILDING DEPT.
SF MF CO ME EL PL DE ENFP
TD
The following is required information -an incomplete application will not be accepted. Please print legibly (in ink) or type.
SITE ADDRESS lq i
ASSESSOR'S TAX/PARCEL #
-
�� s 0-0770
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page for to ohy legal description)
PROJECT• •
SUITE/UNIT #
LOT SIZE (sfl C) a
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING 't� FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of Mork included on this permit onlul
LAY
PROJECT NAME (Name of Business or Owner Last Name) 4 I dy
PROPERTY
OWNER
CONTRACTOR
COPY of a T jr
.vith each Pl
APPLICANT
i
PROJECT
NTAC
LENDER
EXISTING USE
NAMEPRIMARY
�t l n t-� .
APPLI T NAME
, "rKQ&�"_
PHONE
MAILING ADDRESS
5 h
CITY, STATE, ZIP
$ S
E-MAIL ADDRESS
,A-�7 <
-
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent 9,Other
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
,MAILING ADDRESS ^� ; n
I� TY, STATE, ZIP _ �OA I
i/t�� fiX'_PIIRAATION
�<-3 ) �� — I L/ L1 ^
.JC
C--IITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
DATE
FAX NUM13Et`RR
'206L4.10S 8
1Vg1 d
-
CONTRAACCT�O�R'SS R,E�GISTRATION NUMBER
EXPIPATI DAT
E-MAIL ADDRESS
/4
COMPANY NAME
Q�z lS/
APPLI T NAME
, "rKQ&�"_
OFFICE PHONE
MAILING ADDRESS
CITXSTATE, ZIP
CELL PHONE
n V 't�CtO'i
1...) I T .
-
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent 9,Other
()53_) 1?>/ _19,7212i
NAME�! 1 , �t ^ (RIMA - / PHONEq I — os-�� 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 $tT ✓ [, O
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED? [_i YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN o HIGHLINE ❑ PRIVATE (SEPTIC)
-S—
AREA DESCRIPTION
EXISTI
SQ.
PROPOSED
SQ. FT. -
TOTAL
SQ_FT.
BASEMENT
FIRST
o NEW o ADDITION
o ALTERATION
❑ REPAIR o TENANT IMPROVEMENT
SECOND
BASIC PLAN?
o YES
THIRD
ZONING DESIGNATION
ADDITIONAL FLOORS (DESCRIBE)
o YES
o NO
NEW ADDRESS REQUIRED? o
DECK (❑ COVERED OR ❑ UNCOVERED?)
UP/SEPA/SU?
a YES
GARAGE O CARPORT ❑
PLATTED LOT? ❑ YES ❑ NO
DEMO PERMIT REQUIRED?
NUMBER OF FLOORS
F.X75T1R6
PROPOSED
TOTAL
TOTAL =STJN0 Sr
TOTAL PROPOSED Sr
TOTAL Sr
"NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or
Value of Mechanical Work
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS for Tub/Shower Combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
(A COPY OF BID QR ESTIMATE
EVAPORATI V F/COOL
FANS
FIREPLACE INSERTS
FURN ES
GAS G SETS
LAYS team.00m Sinks)
RAINWATER SYST
SHOWERS
SINKS
SUMPS
of this project. Do not include existing fixtures to remain
%GA
NCLUDED WITHAPPLICATION)
IPE OUTLETS WOODSTOVES
GAS WATER HEATERS MISC (Describe)
HOODS tcomm«<t�
_ RANGES
REFRIG. SYSTEMS\
URINALS MISC (Describe)
VACUUM BREAKERS
WATER CLOSETS rron�t)
WASHING MACHINES
I certify under penalty of perjury 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 anddefense 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.
NAME/TITLE Z , C'1(1 L C
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner D Agent D Contractor ❑ Architect D Other
TE
FI��C*,�Ex��hSE F LIQ
o NEW o ADDITION
o ALTERATION
❑ REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑ NO
BASIC PLAN?
o YES
c NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
o NO
NEW ADDRESS REQUIRED? o
YES ❑ NO
UP/SEPA/SU?
a YES
o NO
PLATTED LOT? ❑ YES ❑ NO
DEMO PERMIT REQUIRED?
o YES
o NO
Bulletin #100— April 2, 2007
Page 2 of 4
k\Handouts\Perinit Application