07-106311 elrf M
� • .•
�ralWaY RECEIVED PERMIT 9�ga3 -7 - ( .G 3 t
• OOMMUATIYDItVELOPMBM saRY1CL5 SF MF CO ME EL PL DE EN a)
• ""S`ut MINUS
SOUTH•roBOX
""' APPLICATION
WAY,WA 91063.9718 N O V 2 U r _,____7___________L_. _
2534354607.EDEAL FEDERAL WAY,
953.835 2669
poutth 1lhderohrcu.000
The following is re Y F FEDERWAY
j86AL 1Q�an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
%3
SITE ADDRESS Qs ' cS w. 3 3 G r4#- s att-t2-0' '
ASSESSOR'S TAX/PARCEL i ( - J� / swum=P •
t -irG v a LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Aane Estates,Lot 1)
(MK*••P!r.miler kilt"kid d Y
■ PROJECT INFORMATION
TYPE OF PERMIT ❑BUILDING O PLUMBING 0 MECHANICAL
❑ DEMOLITION 0 ELECTRICAL ❑ ENGINEERING IP FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
1)1)-- 0-40e ri11 55,4,:76-k-/ Try e/rot, tr' TO 02- -360
PROJECT.NAME(Name of Business or Owner Last Name) Det)-144-Ai 13 (J C C Tl/I l k,f . ,4Re-1 J s�k 6
• PEOPLE INFORMATION
•
POWNER OPERTY NAME fe—r29.96‘CitL
) n! 54PRIMARY PHONE -
LINO AD //J ( )2 �_ ��, 2 CITY,STATE,ZIP E-MAIL ADDRESS
✓ l 0 Aw,„„ 4.,,h Pew r
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
•
1M>"ip ,/i l=ake- e�- GI�n e6 -0i4 ,psi' (4/acl d7/ - So 6 /
MAILING ADDRJss ,STATE,ZIF CELL PHONE
•
aC & ' (9(0 if - too- 1Yes-to (.244 )4ra -CosC9)
OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
�� l2 -? , .o1(71O73lo
NTRACTOR'S REGISTRATION RUMMER EXPIRATION DATE ' ' EMAIL ADDRESS
flaiiP /(s-rcvl vi-d)- 07
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE/ / �G
RELATIONSHIP TO PROJECT ( ) ` - a d- l
FAX NUMBER
0 Architect 0 Tenant 1pAgent 0 Other (c/?)„) (31'9 -//J
/jJ•
PROJECT NAMEPRIMARY PHONE
E-MAIL ADDRESS
CONTACT cc
--• ( ) -
LENDER 1V AME Per RCW 19.2.7.095:
Lender information is requ , • -• set value exceeds$5,000
MAILING ADDRESS • CITY,STATE,ZIP '.ONE
■ DETAILED BUILDING INFORMATION
•
• EXISTING USE •POSED USE
EXISTING ASSESSED/APPRAISED VALUE VALUE OF PROPOSED WORK $. 62/--45"a 4)
f
BPRINKLERED BUILDING? a YES ❑NO FIRE SUPPRESSIO' = • • • .•:ED/REQUIRED? a YE S ❑ NQ—
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE a TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
• PROJECT FLOOR AREAS
, AREA DESC• i• ON EXISTING PROPOSED TOTAL
SQ:FT. SQ.FT. SQ.FT.
BASEMENT •
•
FIRST .
SECOND
•
•
•
THIRD •
. S
ADDITIONAL FLOC.: (DESCRIBE)
DECK(0 COVERED OR I UNCOVERED?
•
GARAGE 0 CARPORT 0 •
D
NUMBER OF FLOOR °I'a rTOTAL TOTAL saeraw ss rorscrsaroessu TOTAL BP
"NEW HO.'..c ONLY" NUMBER OF BEDROOMS MATED SELLING PRICE $
• 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(C.w h
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS.
PLUMBING• •
BATHTUBS(orThb/ShowerComn.) LAYS I5.uw.aSb,k4 URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS paid)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES .
HOSE BIBBS SUMPS •
SIGNATURE
I certify under penalty of perjury that I am the property owner or authorised agent of the property owner.I cert{fj 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 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 regulating construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, lupensss, 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,but only
where such claim arises out of the reliance of the city,including its officers and employees,upon•the accuracy of the information supplied to
the city as a part of thi application. •
r�
SIGNATURE: ./ DATE f r--egb 0 a
Property Owner and/or Authorized Agent .
•
o NEW o ADDITION a ALTERATION a REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? • a YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES o NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO •
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO• •
•
Bulletin#100_August 16,2007 Page 2 of 4 . k Handouts\Permit Application