04-100797COMMUNITY DEVELOPMENT SERVICES
33530 FIRST WAY SOUTH • PO BOX 9718
My of , FEDERAL WAY, WA 98063-9718
Federal way PERMIT APPLICATION 2536614115• FAX -,253-661-4129
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For of« U. oray: I FW File Number: L% � - 1 /) () j &L—L - U Ce.'/ I / /
The followinq is
- an incomplete application will not be accepted. Please print legibly (in inkj or
hl 1 p
SITE ADDRESS: i �; r i� ' (�r r;l p SUITE/APT #
ASSESSOR'S TAX/PARCEL #: _ _ _ _ _ _ - _ _ _ _ SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTION (e.g.: Acme Estates, Lot 1) 131 -
(Attach separate page for lengthy legal description)
PROJECT• - , •
TYPE OF PERMIT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING1 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Prouid Wetailfd description of work included on this permit onluh.
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PROJECT NAME (Name of Business/Owner Last Name): 4 -
PEOPLE 1 • - •
PROPERTY NAME: PRIMARY PHONE:
OWNER: V_ I✓,-,)
MAILING ADDRESS (3TREET*DDRFSS;): CITE, STATE, ZIP I 1
1 2-9100 QAC\
CONTRACTOR: NAME T
MAILING AD SS (STREET ADDR SS;
LENDER:
(if P -Pp d VQue > $5,0001
APPLICANT:
l: TUC F UC.KAL WAS tlUJ11V6JJ I.II.G{vJG Iv M�GK:
CONTRACTORS REGISTRATION NUMBER:
co f card required with each application(,
PANY
ZIP CELL PHONE:
EXPIRATION DATE: FAX NUMBER
IZ/ 3i /C ( )
NAME:
NAME: DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS;(: CITY, STATE, ZIP
DATE:
2 -
NAME:O
PANY
',OMPA
OFFICE PHONE:
�jyo�6An\A��
MAIL N ADDRESS (STREET A
CITY, SLNI E, Air
EVENING PHONE:
DESS(:
-
RELATIONSHIP TO PROJECT:
FAX NUMBER:
❑ Architect ❑ Tenant ❑ Other (Describer
CONTACT PERSON FOR THIS PROJECT: ❑ Property Owner ❑ Contractor ❑ Applicant E-MAIL ADDRESS:
DETAILED 1• I INFORMATION
EXISTING USE: PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: ,YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
■ PROJECT FLOOR AREAS
AREA DESCRIPTION
FMSftNG SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
a NEW ❑ ADDITION
o ALTERATION
❑ REPAIR o TENANT IMPROVEMENT
FIRST
BUILDING SHELL ONLY? ❑ YES ❑ NO
BASIC PLAN?
a YES
SECOND
ZONING DESIGNATION:
CHANGE OF USE?
THIRD
a NO
NEW ADDRESS REQUIRED? a YES o NO
UP/SEPA/SU?
FOURTH
a NO
PLATTED LOT? o YES o NO
DEMO PERMIT REQUIRED?
ADDITIONAL FLOORS (DESCRIBE)
o NO
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS?
TOTAL EXISTING
TOTAL PROPOSED
TOTAL EXISTING AND PROPOSED
—NEWHOMES ONLY" NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
Indicate number of each type of fixture that is to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECfIANICAL
Value of Mechanical Work
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
PLUMBING
BATHTUBS (or Tub/Shower combo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS (Bathroom Sink
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS REFRIG. SYSTEMS
HOODS (comm—w) WOODSTOVES
RANGES MISC (Describe)
GAS WATER HEATERS
WATER CLOSETS (.ijet) MISC (Describe)
DRINKING FOUNTAINS
RAINWATER SYS
HOSE BIBBS
ELECTRIC WATER HEATERS
]ISCLAIMER/SIGNATURE BLC
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 only where such claim arises out of the reliance of the city,
including its officers and employees, upon the Szccuracy of the information supplied to the city as apart of this application.
NAME/TITLE: l\�•l1 ' �el_JV
(Signature)
RELATIONSHIP TO PROJECT: 10 Property Owner ` ❑ Applicant
(Title)
❑ Contractor ❑ Architect
FOR OFFICE USE ONLY:
a NEW ❑ ADDITION
o ALTERATION
❑ REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑ YES ❑ NO
BASIC PLAN?
a YES
o NO
ZONING DESIGNATION:
CHANGE OF USE?
o YES
a NO
NEW ADDRESS REQUIRED? a YES o NO
UP/SEPA/SU?
o YES
a NO
PLATTED LOT? o YES o NO
DEMO PERMIT REQUIRED?
a YES
o NO
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