Loading...
09-101920 RECEDED • i Feeral Way MAY 272009P E RM IT _62 - - _L d1 11. 0 SF MF CO ME EL PL DE E ©, COMMUNTIY ThAVENUES0U775 'I SERVICES OF titATI0N 3332FEDERAL WAYSWA 9806 8 F E i \, -i TD 253-835.2607•FAX 253-83 -2609 Twu n;yn tderaLt ny rom The following is required information-an incomplete application will not be accepts . Please print legibly(in ink)or type. • PROPERTY INFORMATION rte �p SITE ADDRESS- A h 330I\ Sf5 _ (� SUITE/UNIT# 6. A 0 ASSESSOR'S TAX/PARCEL N q. 2- to q v - 0 :4. 1 `— LOT SIZE(sj) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal description) • PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING ! FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed ctescription of work included on this permit onitj , Scn I itii Fie SFS �tllYe (tti - eio_41. )r i ri kl�' st r 'Y 10 ar omf s i ,WAM' . PROJECT NAME(Name of Business or Owner Last Name) A sc... c Ref'Ve-S rr _ n447 • PEOPLE INFORMATION PROPERTY NAME p + ^A PRIMARY PHONE OWNER /1 ST Feder�/`n�1r/�uoca,i �l�:I(CVr1)I/r} �f). Q4f�.�]�j(� ) - MAIXNG 140 t DC S IA�-1 1 i 9 ^�-V' I`A ia_k-e ile(C i Mk O� T V2..iOMAIL ADDRESS CONTRACTOR COMPANY NAMEAPPLICANT NAME OFFICE PHONE t it smi-v, Fire er Inc. Veron)ca-VI1(AD-n(10 ( 25- ) N% - G68 MAILING'ADDRESS I` -�•, P CITY,STATE,,ZIP ���/\ CELL LPHONE CITY(0.E SWAY BUSINESS\ RJ(ICENS NUMBER 1w)XPI i-k_.,W I ciFAX NUMBER V., 10-16/.-. 0OD° ss-- OD- /34-- 3 jlo(i (�3)VaC -2350 O CONTRACTOR'S REGISTRATION NUMBER TION DATE E-MAIL ADDRESS 31eV\I-7—H F5' I3(0 U (._\\ -2- - 1 APPLICANT COMPANY NAME P LICANT NAME OFFICE PHONE h A _` 1 1 ((7�� Srnah F7r &(/, m hey . Verordra. l(tmaksn.36 (ZS-3)�;'o - Sgt.) 10 �, I iVCE CITY, /5,0-L'//+.G(_ 10/7 / $Y)V ZIP CELLPHONE - RELATIONSHIP TO PROJECT / i FAX NUMBER 0 Architect 0 Tenant ❑Agent /Other e/ ' U L (Z,3)11 C -73 PROJECT j� PRIMARY PHONE 4 I E-MAIi,/ypD 5-���,�j�/, CONTACT NAME,/► ���CX�� (25-3) ? 6' - /U�� /no-//� Or �1'"//�r f� - C LENDER NAME'/,l�/ Per RCW 19.27.095: Lender information is r-ui -• . ct value exceeds$5,000 MAILING ADDRESS COY,STA • PHONE ( ) • DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ a.7 SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) I • PROJECT FLOOR AREAS E AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST SECOND THIRD ADDITIONAL FLOORS(DESCRIBE) DECK(0 COVERED OR 0 UNCOVERED?) GARAGE 0 CARPORT 0 NUMBER OF FLOORS =STING PROPOSED TOTALTOTAL O SF TOTALPROPOS=SP TOTAL SF "NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED 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$ C 7� • (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPIICATIOM 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 Sink.) URINALS MISC(Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS(ToSeq 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 certlfg 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 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, but only where such claim arises out of the reliance . ,_,including its officers and employees, upon the accuracy of the information supplied to the city as a part of this ap. ication. SIGNATURE: . J DATE O _ V Prope.• • er and/or Authorized Agent — FOR OFFICE USE ONLY o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT BUILDING SHELL ONLY? o YES o 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? ❑YES ❑NO PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application