08-101682 40 �C/.,,A RE ED C X �(yam} ( 8
cirroF - V 11�
Federal Way PERMIT
COMMUNITY DEVELOPMENT SERVICES APR 0 9 2008 SF MF co ME EL PL DE EN )
33325 8TH3-8 AVENUE SOUTH•PO BOX 9718 O F FE ! 1PATTv ' O N � �
FEDERAL WAY,WA 9806 ,�($� _ TD
253-835-2607•FAX 253-8 5-ir�i16 1V
www.ntlioffederaltuag.com
Tic.
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
•,I PROPERTY, INFORMATION
SITE ADDRESS 3702 Z I 51-n N G `W
S SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
II PROJECT INFORMATION
TYPE OF PERMIT 3 BUILDING ❑ PLUMBING Cl MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING Cl FIRE PREVENTION SYSTEM
PR JECT DESCRIPTION (9.collidc detailed description of work included on this e t on1
c / 12 [ (-) � AND 1 Vt1() SP )A i S IA) AFOLLY
S;VI AVLEIE O &) 1 LDA 6—
N 0 Rc5E2 1U0 [ rJCLQ I)0 114 IS 1 I .
PROJECT NAME(Name of Business or Owner Last Name)
• PEOPLE INFORMATION
PROPERTY () /'/G )/Gi� CRfS 1AK . ( 3)H
RY
ONE OWNER ill() U U 0
lig ADDRE �z,�O�il OE CITYSTATE,ZIPO m 972o2 MAIL ADDRESS
CONTRACTOR C__MPj5IY T Ft n C y,({o L `APPLICANT NA O P)A.-- 5 -K9`V/
V��/►Y{VI IIJ�[, N�if�/�J N LY�C 0d1'q�Of�� �!L/
/AILING
Si CELL
7 )NZZE f41'ZZ CiicN45 o 9MIS. 7 / 22 -40 5
CIT �_FEDERA; INESS LICENSE NUMBER EX RAT RtoO % �DA FAX NUMBER 0���
/
CONTRACTOR'S REGISTRATION NUMBER E AST ON DATE60 )656
E-MAIL`,JADDRESS
r,lS i T r c 9 (14 0Y/0 1 Z.-3t-og X4[ExPikwro2n,CCM
APPLICANT COMPANY NAME ALICANT NAME OFFICE PHONE
S�O4')g /25 Ci��D(Z ( ) —
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
(
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant ❑Agent 0 Other ( ) -
PROJECT
/
CONTACT ME p.0614041
.0 r 1 W T `4-�V?cb�c L�3 2 �UA1'/ /V �tJlJ j
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING AD•'E.S I CITY,STATE,ZIP PHONE
(
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 7 f R .d°
/
SPRINKLERED BUILDING? `.> YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER �CAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 10 HIGHLINE 0 PRIVATE(SEPTIC)
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ. FT. SQ. FT.
BASEMENT
FIRST
SECOND 0.-
THIRD
+THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑ COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL ST
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
5 FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work$ . (A COPY 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)Commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(milt)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the best of my
knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with all applicable
City of Federal Way regulations pertaining to the work authorized 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 regulating construction or environmental laws.
I further agree to hold harmless the City of Federal W--y as to any claim (including costs, expenses, and attorneys'fees incurred in the
investigation and defense of such claim), which may be •de by any •erson, including the undersigned, and filed against the city, but only
where such claim arises out of the •licence oft e city, ' eluding i •fficers and employees, upon the accuracy of the information supplied to
the city as a part of this a.• .
` ///
SIGNATURE: 1 - DATE 4-8-08
.f.-rty Owner and/or:Pi orized Agent
FOR e t 1
❑ NEW o ADDITION o ALTERATION ❑REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES ❑NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES a NO
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application