09-100966CUT F A * /00 �,6
t4ECE1
Federal V �
CommuA TYDEVELOPMSNT PERMIT SF MF CO ME EL PL DE EN P
33315E AVENUE, WA POB71 A R 1 3"'APPLICATION
FEDERAL WAY, X 98063.260
� 253-835?607• PAX ?53.835?60g
waur.df
F FEDERAL WAY
The following is requ n - an incomplete appn will not be acceptee. Please print hgOly ftn ink/ or
SITE ADDRESS OD �,y -7r/
SUITE/UNIT #
ASSESSOR'S TAR/PARCEL # — — — — — — — — — — LOT SIZE (31)
LEGAL DESCRIPTION (e.g. Acne Estates, Lot 1) ZVI 4c
•.••••..ate, "King Fire & Rescue
PO!►TED SET OF PLAnrG ❑ PLUmnrGea
'Ittached det ifs
WALL BY HOOD ACTUATION DEVICEmm noN o ELECTRICAL t76PNGnNEERnrG ON SYSTEM
PROJECT DESCRIPTION (Pinuide detaIled deserphon of work vwha d ona
ON e t—_31 /i Un <,,
PROJECT NAME (Name ofag== or Owner Last Namel
PROJECT
CONTACT
LENDER
PEOPLE I iPOMILITION
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
-
OFFICE PHONE
s �,�� s'
CELL PHONE
_ e
obi _
MAILING ADDRESS
CITY. STATE. P
PHONE
�j
x S
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION
D#TE
PAX NUMBER
CONTRACTOR'S REGU TRATION =KB=
E7PMATWN DATE
ADDRESS
fE-MA
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
-
MAUNG ADDRESS
CITY. STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
o Architect o Tenant o Agent 13 Other
( _
NAME
QK � �r�s- 3 � � E-MAIL ADDRESS
NAME
RCW 19.27.095.
Lender information is required f f pro jsct vahm suaeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
E313MG USE PROPOSED USE
ERISMG ASSESSED/APPRAISED VALUE $VALUE OF PROPOSED WORN $����ti �-
3PRIIiKLERED BUILDING? O YES O NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? O YES O NO
WATER SERVICE PROVIDER 0 LAKEEEAVEN 0 RIGS LLINE 0 TACOMA o PRIVATE (WELL)
SEWER SERVICE PROVIDER O LAREHAVEN 0 HIGHLINE 0 PRIVATE ISEPTICI
AREA DESCRIPTION
EXISTING
80. FT.
PROPOSED
80. FT.
TOTAL
SQ. FT.
BASEMENT
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
FIRST
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
SECOND
SUMPS
NEW ADDRESS REQUIRED?
a YES o NO
THIRD
a YES
a NO
PLATTED LOT?
ADDITIONAL FLOORS (DESCRIBE)
I DEMO PERMIT REQUIRED?
DYES
a NO
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
ewrnm
n'eo'n°
Tore''
rarenaZINIMAr
rormnornesesr
Tonmsr
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fuctur a to be installed or relocated as part of this project. Do not include existing fi etunes to remabL
Value of Mechanical Work $ (A C PY OF BID OR ES77MATE M=BE INCLUDED WITHAPPLICATIONJ
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC (Describe)
BOILERS FIREPLACE INSERTS HOODS
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG. SYSTEMS
BATHTUBS (:7vb/M—Cembq
LAVS me&==sk&4
URINALS ` MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS (raO
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
NEW ADDRESS REQUIRED?
I cartVy under penalty ofperjury that 1 ace the property owner or authorised agent of the properly owner. I cwtgy that to the best of my
knowledge, the information subm ittod in support q/ this permit application is twee and cervcG I cort(& that I will compbj with all applicable
CUM of Federal Way regulations pertaining to the work authorised by the issuance of a permit: ! understand that the issuance of this permit
does not r+smove the owner's responsibility for compliance with local, state, or federal laws regulating construction or environmental laws.
!further agree to hold harmless the City of Federal Way as to any claim /including costs, expenses, and att'nneys' fees incurred in the
investtge tion and d4/ense of such ckdn* which may be mads by any person, inch -ling the undersigned, and flied against the city, but onIg
where such claim arises out of me reliance of the Dict/, including its gBicers and employees, upon the accuracy of the Wormation supplied to
the city as apart of
SIGNATURE: nAqqr
o NEW o ADDITION
o ALTERATION
a REPAIR a TENANT IMPROVEIIIF.NT
BUILDING SHELL OIILY?
o YES o NO
BASIC PLAN?
a YES
a N0
ZONING DESIGNATION
CHANGE OF USE?
a YES
o NO
NEW ADDRESS REQUIRED?
a YES o NO
UP/SEPA/SII?
a YES
a NO
PLATTED LOT?
o YES o NO
I DEMO PERMIT REQUIRED?
DYES
a NO
Bulletin #100 —January 1, 2009 Page 2 of 4 MandoutsTermit Application