07-105013ova U4-
F iWwPECEIVED -.
PERMIT'
CON wRITYDj;MopMw5ARYlCBB SF MFC ME EL PL DE EN IT
999?SdftAU WAY,OUIIi• APPLICATION
?EMU WAY, WA 9d=P' 10.2007
069•
ZS$ -W$ -?•07• FAX 2S9d95d6d9 .
%;ire OF FEUERAL WAY
The j011owing is M4"60QW9on - an incomplete application will not be accepted. Please print.legibby (in ink) or We.
/�
, - ,cam
PROPERTY • •
SITE ADDRESS _ L 0 4 `�"' !� Z � � SUITE/UNIT �
ASSESSOR'S TAR/PARCEL # . C� C� - t� LOT SIZE (s�
LEGAL DESCRIPTION (e.g. Acme Rstates, Lot 1)
■ PROJECT INFORBIATION
TYPE OF PERMIT O BUILDING O PLUMING . , MECHANICAL
O DEMOLITION o ELECTRICAL O ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION�(P-r-owde detailed descgription of work incluuded on Otis vermit only)
Van Ala K I'C VI (A to \ �'�� 1 i �1•z� f >-C v
PROJECT. NAME (Name of Business or Owner Last Name)
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
PEOPLE INFORMATION
NAME—
APPLICANT NAME
N
PHONE
L
I Gr
'1 yl
`/PRIMARY
-
MAILIN DRESS
S
ZIP
CITY, STATE, ZIP
E-MAIL ADDRESS DRESS
TION DATE
FAXNUMB5R
CONTRACTOR'S RSOISTRATIOR NUMBIREXPIRATION
DATE
MPANY NAMEAPPLI
APPLICANT NAME
N
OFFICE PHONB
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect O Tenant a Agent o Other
FAX NUMBER
( _
MAIMGADDR1WBTATB,
S
ZIP
PHONE
CITY OF FEDERAL WAY BUS1NB89 LICENSE NUMBER .
TION DATE
FAXNUMB5R
CONTRACTOR'S RSOISTRATIOR NUMBIREXPIRATION
DATE
EMAIL ADDRESS
1i1 �c-1
."7 , i
-1 J, F1qL3
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
-
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect O Tenant a Agent o Other
FAX NUMBER
( _
NAME PRIMARY PHONE EMAIL ADDRESS
NAME
per RCW 19.7.7.098r
Lender information is required ijproject value exceeds $5,000 .
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER
SEWER SERVICE PROVIDER
o YES O NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES o NO
o LAKEHAVEN o HIGHLINE o TACOMA o PRIVATE (WELL)
o LAKEHAVEN 13 HIGHLINE 13 PRIVATE (SEPTIC)
PROJECT ••-
AREA DESCRIPTION
BASEMENT
AREAS
-EXISTING
8 : FT.
PROPOSED
SQ. FT.
TOTAL
SQ. FT.
FIRST
o YES. a NO
BASIC PLAN? '
o YES
SECOND
ZONING DESIGNATION
CHANGE OF USE?
THIRD.
ONO
NEW ADDRESS REQUIRED?
a YES o NO
ADDITIONAL FLOORS (DESCRIBE)
a YES
ONO
PLATTED LOT?
DECK (0 COVERED.OR O UNCOVERED?)
DEMO PERMIT REQUIRED?
o YES
o NO.
GARAGE 0 CARPORT O
NUMBER OF FLOORS
ac s
rsoroaso
MAL.
roa¢smraw•ar
fonaPROPOSED sr
rsrsesr
•'NEW HOMES ONLY".. NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of furture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work $ G� (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLtcATIONJ
AIR HANDLING UNITS
BBQ3
BOILERS
COMPRESSORS
DUCTS
BATHTUBS (or Tub/ah—Comb.)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
OAS LOG SETS
LAVS Isatb,om swo
RAINWATER SYST
SHOWERS
SINKS
SUMPS
GAS PIPE OUTLETS
GAS WATER HEATERS
HOODS Icomm.,d.q
RANGES
REFRIG. SYSTEMS'
URINALS .
VACUUM+ BREAKERS
WATER CLOSETS (rw"
WASHING MACHINES
WOODSTOVES
MISC (Describe)
MISC (Describe)
! esrtVy under penalty of perjury that I am the property owner or authorised agent property 9 4f the p Pill owner. I cert{J y that to the beet of my
knowledge, the information submitted in support of this permit application is truo and correct I cwto that I will comply with all applicable
City of Yederal.Way regulations pertaining to the work authorised by the issuance of a permit I understand that the issuance of this permit
does not remove the owner's responsibility for compliance with local, state, or federal laws rogulating construction or environmental laws.
Z 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 la which may be made by any person, including the undersigned, and flied against the city, but only
where such claim t of re ce of the city, including its officers and employees; upon•the accuracy of the information supplied to
the city as a part yj£hI t n. ,
SIGNATURE: -- DATE
Property Owner and/or Authorized Agent
o NEW a ADDITION
o ALTERATION
o REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY?
o YES. a NO
BASIC PLAN? '
o YES
o NO
ZONING DESIGNATION
CHANGE OF USE?
a YES
ONO
NEW ADDRESS REQUIRED?
a YES o NO
IIP/SEPA/SU?
a YES
ONO
PLATTED LOT?
a YES ONO
DEMO PERMIT REQUIRED?
o YES
o NO.
Bulletin #100=August 16, 2007 Page 2 of 4 . MHandoutsTennit Application .