07-101104- 102 L Q
CRY OF "-^V
Federal V4lay
PERMIT
SF MF CO/ ME EL PL DE
EN\f
COMMUAMDEVELOPMENTSERVICE
33325 00-9718 • PO BOX 9718DERALWA,WA opLICATION
5353852607F28352
wwwcituoaumm
VV
The following is required information - an incomplete application will not be accepted. Please print legibly (in ink) or type.
SITE ADDRESS
SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # 0 -�:L 2 -L Q -q-- - 9 d -?2- - LOT SIZE (sl 20 LIZ3
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) Se -r-+. ti W H Tovnsn•;2 2-1 /La= 4
(Attach separate PWfm I rWft lecxa desc otb V
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ElELECTRICAL ❑ ENGINEERING N(
FIRE PREVENTION SYSTEM
PROJECT
�DESCRIPTION (Provide detailed description of work included on this permit onlu)
Re1dGalr fidcl ozbiaq -iar» wast srae ,,r- r.c fi cast Si ote c>�-'
mcrls fa all Gt ewAelsiavl oC Parikc 14muq S.
PROJECT NAME (Name of Business or Owner Last Namel
PROPERTY
OWNER
CONTRACTOR
COPY of —d required
.,th ewh eppHeettan
APPLICANT
PROJECT
CONTACT
LENDER
NAME
utv,,x Sdrylces LLC c(ea SACH 0;1 P16av&5, US
PRIMARY PHONE
(425 )v13 -tlay
MNILZTG ADDRESS
CITY, STATE, ZIP
E-MAIL ADDRESS
e.eva Mama Va-Ile- / f1N . ##Z7711
Maip)eVe-h WA 9$03
e�nj.P���da@shcli.c
COMPANY NAME
I APPLICANT NAME
OFFICE PHONE
MAILING4kDDRESS
Sa br COnfraCtors 1,1c.
I Amon" 1
(253) 531
- ZILIq
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
�1
❑ Architect ❑ Tenant ❑ Agent [i(Other l/7nfrACtllr
3-g52 S (0(01-J. &
Taco.Y,a w>a e:yq O9
( 253 ) 'a
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
20-0Z- /00d-T(a-00-6L )Z/31/0%
(253)5310
- 20(ofi
CONTRACTOR'S REGISTRATION NUMBER -
EXPIRATION DATE
E-MAIL ADDRESS
�3AYg2CTO33L-4
(011,4100
agr�ncx.I+c(Lo> S439br.con"
COMPANY NAME
S tr 5. 6r.
APPLICANT NAME
Amapeyari
OFFICE PHONE
(253) 531 -Z►
MAILING4kDDRESS
CITY, STATE, ZIP
CELL PHONE
3152 S (o lP t, 3+•
15corn a 1� G $4001
(253) $ - (-1
RELATIONSHIP TO PROJECTFAX
NUMBER
�1
❑ Architect ❑ Tenant ❑ Agent [i(Other l/7nfrACtllr
( 253) X3(0 - 2,06P
NAME PRIMARY PHONE E-MAIL ADDRESS
Am nal Gvi t ( 253) 531 -1"4 rt`ndle@Sd ix.G�
NAME
NIA
Per RCW 19.27.095:
Lender Wormation is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP --[PHONE
EXISTING USE PROPOSED USE S, ,e
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ /5t Otad
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGBQ INE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
S . FT.
BASEMENT N I P
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
FIRST
COMPRESSORS
FURNACES
RANGES
SECOND
GAS LOG SETS
REFRIG. SYSTEMS
❑ YES ❑ NO
THIRD A
❑ YES
❑ NO
ZONING DESIGNATION
ADDITIONAL FLOORS (DESCRIBE)
CHANGE OF USE?
❑ YES
❑ NO
DECK (❑ COVERED OR ❑ UNCOVERED?)
❑ YES ❑ NO
UP/SEPA/SU?
❑ YES
GARAGE ❑ CARPORT ❑ O /A
PLATTED LOT?
❑ YES ❑ NO
DEMO PERMIT REQUIRED?
NUMBER OF FLOORS
El EMO
PEoeoem
TOTAL
TOTAL EEMWOSP
TOTAL PEOPOMaF
TOTAL SF
"NEW HOMES ONLY*" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of -lure to be installed or relocated as part of this project. Do not include existingJIxtures to remain.
MECHANICAL
Value of Mechanical Work $,
(A COPY OF BID OR ESTIMATE MUST BE RVCLUDED W1 HAPPLICATION)
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
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 (Tolle[)
SINKS WASHING MACHINES
SUMPS
I certify under penalty of perjury that the Wormation 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 cityeluding its officers and employees, upon the accuracy of the igformation supplied to the city as a part of
this application. t r
NAME/TITLE
3-1-0
RELATIONSHIP TO PROJECT
❑ Owner ❑ Agent
Contractor ❑ Architect ❑ Other
FOR OFFICE USE 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\Permit Application