07-101126 CITY OF
Fr
Federal Wg:.y. �G PERMIT — — —
�\ $F MF CO ME EL PL DE EN FP
COMMUNITY DEVELOPMENT SERVICES
33325AVENUE SOUTH•POBOX9718 R 7XppLI CATI O N
FEDERAL WAY,WA 98063-9 71 8 ��" �� � TD -
.253-835-2607•FAX 253-835-2609
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ww .dh nf`edernhnoucom F FEDERAL WAY / --�-
The following is requir rmation�-pan incomplete application will not be accepted. Please print legibly(in ink)or type.
I
• • S PROPERTY INFORMATION •
f SITE ADDRESS‘271 ZA V F11 OWy 5.41 ` why L,r1/46-1SUITE/UNIT# {
ASSESSOR'S TAX/PARCEL# D 1 1 1 0 - 9 1 1 LOT SIZE (sf)
LEGAL DESCRIPTION (e.g.Acme Estates, Lot 1)
(Attach separate page for lengthy legal description)
NI PROJECT INFORMATION
I
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
❑ DEMOLITION 0 ELECTRICAL 0 ENGINEERING AFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
4 l yr/FHA, It& 4,:-f•-f — ( 1- --1-1e-ttec, i ?& (ito Gr cT --(4-4,-r-'7--
PROJECT NAME(Name of Business or Owner Last Name) �l t `7 on.(� �(L . ��l �L{,
(. J , 1,,,s,A
I. PEOPLE INFORMATION
PROPERTY NAME fs, )i , 1 *- I I I L4 ! Crs
OWNER f "�J i e 1 ARY PHOItCprp i _
MAILING ADD ES CITY ATE,ZIP �� U 15 � E-MAIL ADDRESS
112)A -- 2_11tt\, cie c iN rFtko IA)
ii ksisoz3
CONTRACTOR COMP NY N ME APPLICANT NAME OFFICE PHONE
N< aivrof ( boviet,4- t--c-v)
A!LIN S" CIT ST![TE,ZIP C L PHON
e
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Cl FE RAL V7AYBUSfN SS LIG' " a E RAT NDA Y 7��AX NUMBER
• • =A r2 — Ko'- C,(1, LT- 1 Z`� y 0 —' ( ) —
eorY are.rd„7!::
regalrea ��. CONTRACTORS REGISTRAT N NUMBER • ION D E E-MAIL ADDRESS
with each appileatlon I 2 - J
-
APPLICANT COMPANY NAME � ��� �.� AgpLICANT NAME � (��� OFFICE PHONE -
`�` ° L �H[JJ�
•A i,1 G ESS CITY,STA��t,1 I(27 PHONE
RELATIONSHIP TO PROJECT FAX NUMB ER
❑ Architect 0 Tenant ❑Agent 0 Other _ !t i ( ) -
PROJECT NAME}MEPRIMARY,PHONE �] E-MAIL ADDRESS
CONTACT t- Y f� kr4k,(1 (7_4 ;L} / 9S
LENDER NAME Per RCW 19.27.`09
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
'' ` ^ tris . „<a --■. DETAILED=BUILDING INFORMATION 1
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? o YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 TACOMA o PRIVATE(WELL)
A SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE (SEPTIC)
i w.., .. .....,+...,... .,,,,»,......,..:r.,.,...m..,,.m.,,,,.m..n..
AREA e EXISTING PR/i0SED TOTAL
SQ.FT. S•. Fi: SQ. FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR ❑ UNCOVERED?)
GARAGE 0 CARPORT 0
EXISTING PROPOSED TOTAL TOTAL EXISTING ST TOTAL PROPOSED Sr TOTAL Sr
NUMBER OF FLOORS
**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 $ (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(commerdal)
COMPRESSORS FURNACES RANGES
DUCK'S; , • 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 rronet(
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBS SUMPS
•
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.
NAME/TITLE DATE
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent 0 Contractor ❑ Architect 0 Other
o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT.
BUILDING SHELL ONLY? o YES ❑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? ❑YES o NO DEMO PERMIT REQUIRED? ❑YES o NO
•
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Bulletin#100—January 1,2007 Page 2 of4 k\i-landouts\Permit Application
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