07-106252 T 11111 27/ l
RECEIVED 0
Fed,A •
eral Way �— (� ���
Dov 1 6 Nu PERMIT SF MF CO ME EL PL DE ENC.:.)
COMMUNITY DEVELOPMENT SERVIC
333258THR LUTH•PO 99718 pLI CATI O N
FEDERAL WAY,WA 98063-9718 1D /
253-835-2607•FAX 253-83�10 r FED,.,
wtutu.ctn,arrederalwau. BUILDING DEPT.
The following is required information-an incomplete application will not be accepted Please print legibly(in ' or type.
• PROPERTY INFORMATION
SITE ADDRESS 3JVJ(p 5 /W127erh4pL -Sn2 L.65
. SUITE/UNIT*
ASSESSOR'S TAX/PARCEL# C I a J 0 4
ci 0 0 2– LOT SIZE(sj)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal des<npaon)
• PROJECT INFORMATION
TYPE OF PERMIT ❑BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING VFIRE PREVENTION SYSTEM
PROJECT DESCRIPTIO (Provide detailed description of rk includ on this permit only)
PROJECT NAME(Name of Business or Owner Last Name) 1'L2 '/ (hal- S`'Et r CZ rp d OCIL/`1-0 I S
• PEOPLE INFORMATION
PROPERTY NAME
OWNER , A L\J r h a eGt s Y plgivay
rids J GL
.•--
N�
MAILING
CITY.ST Z ! E-MAIL ADD
3 3oe 3kiteyerhieus eru S
CONTRACTOR CO ANY pl.,AME LCANT NAME OFFICE PHONE
i ns 0_0 , lLr1 -RD,i X% ) 33Q -` 5'
CITY.STA - O/4 '1 i3 q F ELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DA FAX NUMBER
! —CAD -000003--ob-81- t.Zf3 j 0 7 � 3 5�al-
Co RESS
e- c I CL �I NUMBE�l A D a) $1�1i 1 a E AEXPIRATION ATE �arn-y P 1-16-K6(15-1-14,„4'
APPLICANT CjY triPyll,CT NAME�lO J 1 OFF )�� ^ may,
-
MMAILING DRESS (� OD
p C ISTtATE �g/� /I/34
/• CELL PHONE X�1 d
5.
C475" rcl)
RELATIONSHIP TO PROJECT �y .,., r FAX NUMBER
❑Architect ❑Tenant 0 Agent Other L,v/7 L / ( ) -
PROJECT PRIMARY PHONE ' E-MAIL ADDRESS
CONTACT CLr g7Dj D, )332 - Yb 5 3- Juane P&IGle Kips ci, fl
LENDERE Per RCW 19.27.095:
� 1 L C(� Lender information is required(f project value exceeds$5,000
MAILING ADDRESS " CITY,
PHONE
5)05 3(cl�Q -j-P- S . o, ,.A` e,, ' I 3q P ( / )'762 - 3.3//
7 • DETAILED BUILDING INFORMATION n �y�� �-
EXISTING USE 0 FI C) eL l)£7 / PROPOSED USE // /// /�-I �ty� ,
EXISTING ASSESSED/APPRAISED VALUE$ 3/, Lo r'1 VALUE OF PROPOSED WORK $ /01 Ow' ��
SPRINKLERED BUILDING? )/YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
S
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
AK THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR ❑UNCOVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL=STING SF TOTAL PROPOSED SF Tore.SF
""NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
• FIXTURES
Indicate number of each type of fixture to be instnllPd or relocated as part of this project. Do not include existing fixtures to remain.
'MECHANICAL oO�/0
VnluP of Mechanical Work$ t (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 5-At MSC(Describe
BOILERS FIREPLACE INSERTS HOODS(Commercial) f)K
COMPRESSORS FURNACES RANGES �j,
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 CLOSLlb nm)et)
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 Way as to any claim(including costs, expenses, and attorneys'fees incurred in the
investigation and defense of such claim),which ma be made by any person, including the undersigned, and filed against the city, but only
where such claim arises ut of the reliance e c ty, ' eluding its officers and employees, upon the accuracy of t a information supplied to
the city as a of th plication.
SIGNATURE: DATE 1 l ! v
Prop Owner d/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 ❑NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100—August 16,2007 Page 2 of 4 k\Handouts\Permit Application