10-101921arvar vAREC"\' E
��,. Y 1t aa�:� PERMIT ���� !MF ssmAA SF CO ME EL PL DE EN FP
33325 8m AVBMIB S U771 • Po BDX 9718
FZDff-• PARL WAY, WA 99063-9718
?53S343S.8352607r- FEoERAP ,I CATI O N
bWO//tp&gbR Qom! 80M not b1 QOOwamc Pimm p!w aww (jam &v pr
ADDRESS 13 30 S
3,-- p -s"
ASSESSOR'S TAWPAWEL # �
LEGAL DON (&g. Acme Estates, Lot 1]
2&ET
Q
PROJECT INFORMATION
_ • � :�'L. 1 � : i I / L [ ■ 1 1:11., [ ■ 1 -H: :I
BU=/U= #
LOT SIZE (sp
PROJECT DSSCBETIOI((Provide deta&d d�[m of wow* vwWded on gw
S
"- I
`N r C&OA2 SC-4AtzLs byL—� P S0LAYb�lr- a
ins
-7 /1,," d54 0 01,_ 5 -P N LFlTH
PEOPLE liVFORMATIO`I
r. t �i r� •
PROJECT
CONTACT
LENDER
IL4.-g :yyl; t IFS
11)%KF—
► 330 S. UJ . 3`{ c`�`'S'f; hEO�A-� l,'J %( �� .etu
;53 ) `t31 - 5.21 I
ernu nra ADDRB.4S
�• v 3e� � 3 ! a 4q PojAt.�vp WA, Qa 37 3 ) CEUPHO06 - (4389
19-00 --13L-
IZ/31 12.016
(a:5-3 ) 5N t) - 3-�i t
LEGE 2c.4t3`t �N U3/,-5- /a�tZ IG-Pp—""A I
coarrANY W
APPLICANT NAME
OMCE PHONE
18A1LII?O ADDItE33 CRY, SYATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
E3 Architect o Tenant o Agent o Other
PAX NUN(tR
� ) _
PRtMA12Y PHONB Z -b" ADD�g
(9S`'3 ) b - 3`t -2a
NAME
P MW 29.27.09&
l is ffpvtct aft* "ow
11AILNO ADDRE93
CRY. STATE, ZIP PHONB
)
E7asT G ASSEWM APPRAISED VALUE $. VJAILIIE OF PROPOSED
N1
3PRn�,ERED sunD>aa? ❑YES o Nons sQPPRESSION syvrm Pito o YES Cl NO
PATER SERVICE PROVIDER o LAMMAVEN o maffim ❑ TACOirA oPRIVATE
EWER SERVICE PROVIDER o LARWAVEN o HICHILM n VRTvAree uaww"r-•
AREA DESCRIPTION
EXISTING
. FT.30.
PROPOSED
FT.
TOTAL
SQ. FT.
BASEMENT
GAS WA TER3 MISC (Deacri
_
_ BOILERS
FIRS12LACE INSERTS
FIRST
_ COMPRESSO
FURNACES
RANGES
SECOND
GAS LOG SETS
REFlSO.3YSTEMS
a YES a NO
THIRD
a YES
a NO
PLATTED LOT?
ADDITIONAL FLOORS (DESC
DEMO PERMT REQUUtW?
a YES
o NO
DECK (❑ COVERED OR ❑ UNCO ?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
soros
:owLsoo ever
��
zoraar
""NEW DOMES ONLY" NUMBER OF BEDROOMS F.STIMATED SELLING PRICE $
Indicate number of each type of fixture to bs .owtailed or relocated
Value of Mechanical Work
(AOF BID OR ESTIMATE
of this pmject. Do not include existing jbdunes to remain.
INCLUDED WWIHAPPLICA77011R
_ AIR HANDLING UNITS
EVAPORATIVE COOLERS
GASOUTLETS WOOD3TOVE3
SBQS
FANS
GAS WA TER3 MISC (Deacri
_
_ BOILERS
FIRS12LACE INSERTS
HOODS
_ COMPRESSO
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFlSO.3YSTEMS
(. T Wmow.rCom6e) LAVS (B.th....Sh** URIIYALS MISC pea nl*
ISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRI MNG FOUNTAINS SHOWERS WATER CLOSETS pw4
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BISBS SUMPS
1 cw yb under penalty of perjury that I an the property comer or authorized a� o property owner. I that to the best of ng
bow- - the information submitted in support .of this permit appttoadeft Cato that I will Comply with an appacoble
CSI of rider at Wey rens perbaining to the work authorised by the issuance a of a paraft ! mutersiand that the issuance of this permit
aloes not remove the owner's responaibi t fir coagAVanee with local, state, or federal taws regulating construction or a strommental laws.
Z j arther agree to hold harmless the City of kederal Way as to any claim /ineheding oasts, aqw nses, and attornegW fees incurred in the
Investigation and dditnm of such ckdn ; which may be made bF erg person, including the undersigned, and filed against the city, but only
where such claire ariess out of the reliance of the ettA buluding its offlcero and—ployess, upon the accuracy of the &Vbrmnatioa =Wpiisd to
the cog as a part of tide arppticaHon. %
BIGNAT. ' ` DATE a
Property Owner and/or Authorized Agent
a NEW a ADDITION
a ALTERATION
a REPAIR a TENANT IN2qOVEN3=
BUILDING SHELL ONLY?
a YES a NO
BASIC PLAN?
o YES
a NO
ZONIIIG DESIGNATION
CHANGE OF USED
a YES
o NO
NEW ADDRESS REQUIRED?
a YES a NO
IIP/SWA/SU?
a YES
a NO
PLATTED LOT?
o YES a NO
DEMO PERMT REQUUtW?
a YES
o NO
Bulletin #100 — January 1, 2009 Page 2 of 4 btlandoutsTermit Application