07-103070 Federal Way ._C2_ _2 - -L:-Q_ Z Q
cOMA:•_•N.JY',DEVELOPMEM'SERVICES REGE L PERMIT SF MF CO ME EL L DE EN
33325 AVENUE SOUTH•PO BOX 9718 •
FEDERAL WAY,WA 98063-9718 PLICATION TO
.253-835-2607.FAX 253-835-2609 JUN 0 5
www.cifituffedemalwau.com
The following is re eQastfagpy¢ Rjt incomplete application will not be accepted. Please print legibly(in ink)or type.
• i , r
- -- - . • . - PROPERTY INFORMATION
SITE ADDRESS G . 331efin st__ SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 7 . ' iiii ('-,- 0 ? _Q LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) •
ro
(Attach separate page for Isdry legal dss,,pdon) .
•
• - ■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING O PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING FIRE PREVENTION SYSTEM
PRO T DESCRIPTIO • . '.e•-ta' -. description of work included on this permit onlU)
P\-1 1 ' I a C - _
PROJECT NAME(Name of Business or Owner Last Name) tO 1 yn Paa 1+ .
- PEOPLE INFORMATION •
PROPERTY NAME
_ PRIMARY PHONE
OWNER C_.,,L.I(/ _
MAILING ADD ESS `
CA.) CITY,STATE,IP E-MAIL ADDRESS
CONTRACTOR ClaMPANY
DNAME AP IN■ 1ME
ZFED 'X
Jr, c Iva
jr-17)7181- 7/e0
£ BUSQESS LICENSE NUMBER V C 'Og 17CLL PHNE
EXPIRATION DA FAX
NUMBER
Cj• a fl .66 ( --oo c Z -3\ - 0-1 ( )• -
CONTRACTOR'S REG TRAT� 1BE�
• EXP/IATI�/ TE E-MAIL
ADDRESS of carol rpalrsa �wltbe application e�DW �� se fVe V
rVwN •V^
APPLICANT COMPANAME Ys" ELI AME♦ OFCEi�
1 -`7 to 61
MAIL ADD- S CITY STA ,ZIP rata I�CELL PHONE -
sLiL tan ...5 t t C� /KJ�i+CL( )
Architect• NSHIP
PROJECT z 81 - ��s
O Architect ❑ Tenant 0 Agent ❑�ther 1�^(�^,`jj,
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT fp 11(6,n. ( )
LENDER NAME Per RCW 19,27.095:
Lender iyereaatin=is required if project value exceeds 55,000
MAILING ADDR SS , ATE,ZIP
---------------71
_ — ^o
(
• 1:- . ' , - - • III -DETAILED BUILDING INFORMATION • -
EXISTING USE • .��y� 6anN2,...*, PROPOSED IISE
EXISTING ASSESSED/APPRAISED V' UE $ . _ VALUE OF PROPOSED WORK $ 2500 4a
SPRINKLERED BUILDING? /YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? �tit YES 0 NO
. WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0-PRIVATE(SEPTIC)
• IT •�O
IQ EXISTING PROPOSED TOTAL
• AREA DESCRI
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD •
ADDITIONAL FLOORS(DESCRIBE) • .
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
EE78TIDG PRoPOEED TOTAL TOTAL=STING■l TOTALPROPOSED Sr TOTAL SF
NUMBER OF FLOORS
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
• FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project. Do.not include existing fixtures to remain.
MECIIANICAL
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(commorciap
COMPRESSORS FURNACES RANGES
Ding; V • 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 gone) •
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
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SIGNATURE
I certify under"penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I
am authorized by the owner of the above premises to perform the work for which the permit application is made. I 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 claim), which may be made by any person,including the undersigned,and filed against the City of Federal Way, 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
this application. (i•
NAME/TITLE DATE /o7. (S(gnatu (Title)
. RELATIONSHIP TO PROJECT wner ❑ Agent ❑ Contractor ❑ Architect 0 Other
o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT. • •
BUILDING SHELL ONLY? o YES 0 NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO •
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? . *a YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
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Bulletin#100—January 1,2007 Page 2 of 4 k\Handouts\Permit Application .