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• Federal Way RECEI�/E4ERMIT F ISS /�
COMMUNITY DEVELOPMENT SERVICES SF MF CO E EL PL DE EN FP
3332E AVENUE SOUTH• BOX 9718 APPLICATION
FEDERAL WAY,WA 9806363-9718 TD
253-835-2607•FAX 253-835-2609
www.cittioffederaiwau.com JUN 2005
The following is re. ' , '• •rmation-an incom.lete a.•lication will not be acce•ted. Please •rint legibly(in ink)or ty•-.
PROPERTY INFORMATION
c •
SITE ADDRESS 333XX Hoyt Road S.W. SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 1 4 2 1 0 3 - 9 0 1 6 LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) See attached
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT X] BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
Grade lots to provide pads for future residential home construction
PROJECT NAME(Name of Business or Owner Last Name) Cottages at Hoyt Road
PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER Cottages at Hoyt Road, LLC ( 253 ) 845 - 2922
MAILING ADDRESS CITY,STATE,ZIP
310-29th St. N.E. Puyallup, WA 98372
CONTRACTOR COMPANY NAME APPLICANT NAME OFF"E PHONE
MAILING ADDRESS CITY.STATE.ZIP CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
(
B L
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
Barghausen Consulting Eng. Daniel K. Ba - (425 ) 251.. - 6222
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
18215 72nd Ave. S. Kent, WA 9302 ( 206 ) 396 - 8588
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent [g Other(Describe) Engine e~' (425 ) 251 - 8782
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
Daniel K. Balmelli (425 )251 dbalmelli@barghauser .com
LENDER Per RCW 19,27.095: Lender',information is NAME
required jf project value exceeds$5,000
MAILING ADDRESS CITY,STATE.ZIP
• DETAILED BUILDING INFORMATIQ11
EXISTING USE Vacant PROPOSED USE 35 lot residential plat
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 60,000
SPRINKLERED BUILDING? o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER o LAKEHAVEN o HIGHLINE ❑ PRIVATE(SEPTIC)
411 •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF 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 $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commemiai) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(orThb/Shower Combo) SHOWERS WATER CLOSETS frotle) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
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.
ttiNAME/TITLE ki I v/l./ _DATE Li/ I
(Signature) mile)
RELATIONSHIP TO PROJECT 0 Owner )(Agent ❑ Contractor a Architect ❑ Other
FOR OFFICE USE ONLY
u NEW u ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? ❑YES a NO
ZONING DESIGNATION CHANGE OF USE? ❑YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? o YES o NO
PLATTED LOT? ❑YES a NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application