07-102852f Y
PRIMARY PHONE
(Yz'-) 2y2- - 2-Y//
' �. RECE•�v -
• CITY OF --
0
Federal Way 2Qo7 PERMIT
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SF MF CO ME EL PL DE EN
COMMUNITY DEVELOPMENT SERVICES
M A
CHY, STATE. ZIP
,�/J f/c �✓./ 986x'7
33325 D AVENUE SOUTH • PO BOX 9718
FEDERAL WAY. WA 98063-9718 G
253-835-2607• FAX 253-835-260.90 r, `. � GO L I C AT I O N
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www.cituof(ederala, .com BUILD
FAX NUMBER
The following is required information -an incomplete application will not
be accepted. Please print legibly (in ink) or type.
PROPERTY• •
CONTRACTOR'S REGISTRATION NUMBER
EXPIRATION DATE
E-MAIL ADDRESS
SITE ADDRESS _ J yp I / /�.i%G���G !% S•
SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # 8 J- 2 S -� 0 %
LOT SIZE (SO
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Aftach -parole page (r lengfhy legal d—cripdan)
PROJECT• •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING
❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL
❑ ENGINEERING,_IrFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
10/Zo41/D,C /w2ZZ&- 5,0121
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PROJECT NAME (Ncune of Business or Owner Last Name) /-/ L P 10A -1A Lp 5
PROPERTY
OWNER
CONTRACTOR
COPY of card required
v
'th each application
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
NAME
IUOVALO' G4G.
PRIMARY PHONE
(Yz'-) 2y2- - 2-Y//
MAILING ADDRESS
/z /3/ 113,1'-,4,,1 A,4�' aDE/o3
CITY, STATE, ZIP
/1i11?Az AA,* Gt4 f6ONY
E-MAIL ADDRESS
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
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e -?414
1?33
MAILING ADDRESS
211' ,rfto,/JT.44G" A✓ 13"8
CHY, STATE. ZIP
,�/J f/c �✓./ 986x'7
CELL PHONE
( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
( ) -
(L5Y) "".3 :r - 0//3
CONTRACTOR'S REGISTRATION NUMBER
EXPIRATION DATE
E-MAIL ADDRESS
410AI
-C9 >
C'?414rfL* ir.2�Sy
COMPANY NAMEAPPLICANT
NAME
OFFICE PHONE
S YSr S G✓e :;
PHONE
( ) -
MAILING ADDRESS
CITY. STATE, ZIP
CELL PHONE
( ) -
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ,,Agent ❑ Other
( ) -
NAME PRIMARY PHONE E-MAIL ADDRESS
C"-eA14 I (zrs) 633 - /z
NAME
Per R 19.27.095:
Lender information is required if project value exceeds $5,000
MAILING ADDRESS
CITY. S'rATE. ZIP
PHONE
PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ -<
SPRINKLERED BUILDING? �O YES C NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?> YES ❑ NO
WATER SERVICE PROVIDER �ke'LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
w.✓sT
V--,07
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
SQ. FT.
BASEMENT
BBQS
FANS
GAS WATER HEATERS MISC (Describe)
FIRST
FIREPLACE INSERTS
HOODS (comm—w)
COMPRESSORS
SECOND
RANGES
DUCTS
_ GAS LOG SETS
THIRD
❑ NO
PLATTED LOT? a YES u NO
DEMO PERMIT REQUIRED? u YES
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
MSTD+G
PROPOSED
TOT v
--G-
Ore1LEXIb G9F`*NEW
-NEWHOMES 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.
Value of Mechanical Work $
(A COPY OF BID OR ESTIMATE MUST BE INCLUDED WI'T'H APPLICATION)
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS PIPE OUTLETS WOODSTOVES
BBQS
FANS
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
HOODS (comm—w)
COMPRESSORS
FURNACES
RANGES
DUCTS
_ GAS LOG SETS
REFRIG. SYSTEMS
BATHTUBS (nr'Nb/Sbo—r Combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
LAVS (Datbmom Sinks)
URINALS MISC (Describe)
RAINWATER SYST
VACUUM BREAKERS
SHOWERS
WATER CLOSETS nbiki)
SINKS
WASHING MACHINES
SUMPS
BASIC PLAN? ❑ YES
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 and defense of
such claim), which may be made by any person, including the undersigned, and filed against the City of Federal Way, but odly 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 �J DATE "%
ignature) ('title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
❑ NEW n ADDITION
❑ ALTERATION
❑ REPAIR -i TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑ YES c NO
BASIC PLAN? ❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE? ❑ YES
❑ NO
NEW ADDRESS REQUIRED? u YES ❑ NO
UP/SEPA/SU? ❑ YES
❑ NO
PLATTED LOT? a YES u NO
DEMO PERMIT REQUIRED? u YES
u NO
Bulletin #100 - April 2, 2007
Page 2 of 4
k\HandoutsTermit Application