08-102751«.oFA RECE14E®4
Federal Way 5 2(PERMIT �'
COMMUNITY DEVELOPMENT SERVICES JUN 0
33325 8T" AVENUE SOUTH • 63 BOX 9718 D 7'� T T ,,AT I O N
FEDERAL WAY, WA 98063-9718 F� 1 _ jy_`L7�� _
253-835-2607• FAX 253-835-2609^Tv OF i�t//•��+J Y r
www.dtuofederalwnu.com ``11 f(`
The following is required informatigDA incomplete application will not be c
SITE ADDRESS
WL S. inl Z q& -r. b ! "r;
ASSESSOR'S TAX/PARCEL # S S 3 Z D O Cr)
,,SF �1V�Fd �� SIL $L�- PL DE E FP
/IAA °Details
J S bject to att chr=.i
legibly (in ink) or type.
LOT SIZE (sf) ( 5000
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) l4A(ZkY--�f— \Il9.w A'pfl T if 0 (704S fr
(Attach separate page for lengthy legal d—iption)
PROJECT• •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING YQFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description
®of work included on this permit only)
(�l'l L -L) 106
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PROJECT NAME (Name of Business or Owner Last Na mel C-Ce4A - -- (7-f S
PEOPLE•• •
PROPERTY
OWNER
CONTRACTOR
t2�,)Db�33
COPY of eaed eegaired
with each applicatba
APPLICPjff
�L 7
PROJECT
CONTACT
LENDER
NAME
PRIMARY PHONE
(z(o ) z� l - o A
MAILING ADDRESS
CITY, STATE, ZIP
7i
E-MAIL ADDRESS
PANY NAME
y d(. est. — t a. V "c f -I bt(c.(en's
APPLICANT NAME
OFFICE PHONE
(Z53 ) 6z'4::'
- ��
MAILING ADDRESS
101"f PO"A
CITY, STATE, ZIP
x�kA-PfJZ_ tL)k Q6,340
CELL PHONE
z53 s6 R
- q0 3S
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
FAX NUMBER
CONTRACTORS REGISTRATION NUMBER EXPIRATION DATE
E-MAIL ADDRESS
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILIN07ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent14-Other
( ) -
NAME PRIMARY PHONEE-MAIL ADDRESS
Q03
NAME
Per RCW 19.27.095:
Lender information is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
( )
EXISTING USE PROPOSED USE S i 06, L -C-
EXISTING ASSESSED/APPRAISED VALUE $ E I (i�%L1 VALUE OF PROPOSED WORK $,
SPRINKLERED BUILDING? *YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER )4 LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
b*`
PROJECT •• -
AREA DESC ION
AREAS
EXIST
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
BASEMENT
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
FIRST
COMPRESSORS
FURNACES
RANGES
SECOND
GAS LOG SETS
REFRIG. SYSTEMS
CHANGE OF USE?
THIRD
❑ NO
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
UP/SEPA/SU?
ADDITIONAL FLOORS (DESCRIBE)
❑ NO
PLATTED LOT? ❑ YES ❑ NO
DEMO PERMIT REQUIRED?
DECK (❑ COVERED OR ❑ UNCOVERED?)
❑ NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
EXIST O
PROPOaED
TOTAL
TOTAL ESISTfNO Br
TOTAL PROPOSED ar
TOTAL sr
"NEW HOMES 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 furfures 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
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
HOODS (commercial)
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
PLUMBING
BATHTUBS (or Tub/shower combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
LAVS (Bathroom sinks)
URINALS MISC (Describe)
RAINWATER SYST
VACUUM BREAKERS
SHOWERS
WATER CLOSETS (Toaet)
SINKS
WASHING MACHINES
SUMPS
BUILDING SHELL ONLY? ❑ YES ❑ NO
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 authorised 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.
r
NAME/TITLE
1..� (Signature) —1 1 (Title(
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑
/s Ike
F'QR OFFICE. LTSE 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, 2007 Page 2 of 4 k\Handouts\Pennit Application