07-101422CITY Op.: t ItUEIVEp
Federal Way PERMIT! 0- L4-a�
COMMUNITY DEVELOPMENT SERvicEMAR 19 20 MF CO ME E_L PL DE EN F
33325' D RAL WA , WA 9• PO BOX 9718 P L I C AT I O N
FEDERAL WAY, WA 98063-9778 D
.253.835.2607•FAXas3.8354WY OF FEDERA
°n""1•°'°°1rc"8walt.cum BUILDING DEPT,
The following is required information -an incomplete application will not be accepted. Please print legibly (in ink) or, type.
SITE ADDRESS - S-2 3 4�§ S W .
9
ASSESSOR'S TAX/PARCEL ti
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
TYPE OF PERMIT
PROJECT DESCRIPTION (Provide detailed
. L"c spa i/ JOD ci
■ PROJECT INFORMATION
SUITE/UNIT 4
LOTSIZE (s])
❑ BUILDING .O PLUMBING O MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
Of work included on
zi
PROJECT NAME (Name ojBusiness or Owner Last Name)
PEOPLE •. •
PROPERTY
OWNER
CONTRACTOR
COPY of -4 regalred
with gpch rppli—tion
APPLICANT
PROJECT
CONTACT
LENDER
NAME / PRIMARY PHONE
MAIL]NO ADDRESS CITY TE, ZIP E-MAIL ADDRESS
Sri
COMPANY NAME •
5 rp
A CANT NA //
OFFICE PHONE
euft
4
zs3) 3 t S--Aqlf
MAILING A D ES
CITfY STATE,
CELL PHONE
l L
CITY OF FEDERAL WAY BUSINESS LICENPE NUMBER
PIRA ION DATE
FAX NUMBER
l D�
CONTRACTQWS REGISTRATION NUMBER
EXPI TION DATE
E-MAIL ADDRESS
14-1Ic—g LD5 5'G�
713-11o.7
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other
) _
Ivn PRIMARY PHONE 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 USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK
SPRINKLERED BUILDING? O YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE O TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN O HIGHLINE 0 PRIVATE (SEPTIC)
PROJECT FLOOR•U
AREA DES IO.N EXISTE POSED
S2. F -SQ. FT.
TOTAL
SQ. FT.
BASEMENT
BBQS
FANS
FIRST
BOILERS
FIREPLACE INSERTS
SECOND
COMPRESSORS
FURNACES
THIRD
DU,C S
GAS LOG SETS
ADDITIONAL FLOORS (DESCRIBE)
o NO
PLATTED LOT?
DECK (O COVERED OR O UNCOVERED?)
DEMO PERMIT REQUIRED? o YES
o NO
GARAGE O CARPORT
'
NUMBER OF FLOORS
E)nin'1110
PROPRMEO
TOTAL
T6TAL EJQSTD G BF TDTAL PROPOSED EF
TOTAL 8l
**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
(ACOP 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 (commereiq
COMPRESSORS
FURNACES
RANGES
DU,C S
GAS LOG SETS
REFRIG. SYSTEMS
PLUMBING
BATHTUBS (or Tub/Sho—r Combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
LAVS )Bathroom Sinks)
URINALS MISC (Describe)
RAINWATER SYST
VACUUM BREAKERS
SHOWERS
WATER CLOSETS (Toiieq
SINKS
WASHING MACHINES
SUMPS
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 flied 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. n n n9
NAME/TITLE
(Signature)
RELATIONSHIP TO PROJECT o Owner o Agent
IWGOn_tr,ctor
t (Title) '
o Architect
o Other
o NEW o ADDITI.ON
o ALTERATION
o REPAIR ❑ TENANT IMPROVEMENT.
BUILDING SHELL ONLY?
o YES o NO
BASIC PLAN? o YES
o NO
ZONING DESIGNATION
CHANGE OF USE? o YES
o NO
NEW ADDRESS REQUIRED?
o YES o NO
UP/SEPA/SU? o YES
o NO
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED? o YES
o NO
Bulletin #100—January 1, 2007 Page 2 of k\Handouts\Permit Application .