07-101607 ,eras Way ,- PPERMIT
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COMM NIPYDEVELOPMENT'SERVICE MF CO ME EL PL DE E FP
33325 D AVENUE SOUTH•PO63 BOX 9718 P p L I C A T I O
FEDERAL WAY,WA 98063-97]8 n �A TD
.253-835-2607•FAX 253-835-2609 MAR y .,: / __��
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• The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• t. . ■ •PROPERTY INFORMATION -. . .1 SITE ADDRESS �J �, E��� SUITE/UNIT# J I 0
ASSESSOR'S TAX/PARCEL# —L X ,5 act 3_ 0 `4 D LOT SIZE (sf)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) Fedevi I Wa y cr-ass,kvds gill f1
/Attach separate page for lengthy legal desorption) J
■ PROJECT INFORMATION •
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL ❑ ENGINEERING -I/FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Providedetailed description of work included on this permit onlu) /A
Add s pr;n/rte.s • e)'1,L sMc/I Sys}P.�., n e•P
Pr T: 1. Wa1(s l ills u,n,•!iJe „ .
PROJECT NAME(Name of Business or Owner Last Name) CO( 1 L �'OW -H riet. ? Z/?0 4-- (V( I
. ■.PEOPLE INFORMATION
PROPERTY NAME" /' /' PRIMARY PHONE
OWNER I APi F,IKK. l�ratio O1 LOh,,,,,1,eS ( ) -
MAILING I v/*'DESS SO 4 O/F y CITY,���TATE, '(� / �� 9�/G� E-MAIL ADDRESS
III MPANY NAME _ O 0
CONTRACTOR 1 APPLICANT NAME OFFICE PHO E I
IL NG A RESS �\ cl Jr,STATE,ZIP
�/��//�� {J�/►'Ay'- (a 1.11 CE L PHONE -
ITY OF FEDERAL WAY BUSINES L .` E NU e•R ` EXP1I AYION DATEEE " FAX NUMBER
COPY of card required "N"^'^..CT.O.{R EGISTRATION N� Ett" EXPIRATION D E E-MAIL ADDRESS
with each application I .}� ` r �,/��j( F I yVy —
APPLICANT OMPANY NAME /Y(b(/`� APPLICANT NAME (//J��[, OFFICE PHONE
wA1.li► 1 - AA./ A .. A. .` A ' ( A
//n1.1 L ��))DD• SS /� ST/ TSE,,ZIP
/^/� 1 /CE L P *NE
' ��♦
(�ELIONS PROJ i�{\�, \a l�_1 , v I " ���� %� FAX NUMBER
•
❑ Architect ❑ Tenant/ )❑Agent 0 Other _q
rn
u
PROJECT PRIMARY PHONE E-MAIL ADDRESS
CONTACT \nC ( '1RYa (.12' A61 1
LENDER NAME Per ROW 2927.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
(
y: . ■.-DETAILED BUILDING INFORMATION
EXISTING USE Gi Ai,k i) 1.--e{-e1; I " PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ . , VALUE OF PROPOSED WORK $ 4/00 ' 00
SPRINKLERED BUILDING? YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES p NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
•
I � � ,fla, .:re .1et' , Y iPZ._• . 1'^''''•:..''.::i..,',".,:.;...:!:.:...;.'.,:
T . ri '•.. �.��.• sT{ .:._ .
AREA DESCRI EXISTING PROPOSEDTOTAL I
SQ. FT. SQ. FT. SQ.FT.
L
` BASEMENT .
FIRST
•ECOND
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT Q
EXISTING PROPOSED TOI AL TOTAL EXISTING Sr TOTAL 150105E19 ST 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 Icommercio)
COMPRESSORS FURNACES RANGES
DUCTS ., • .. GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS)or Tub/5howerCombo) LAVS(Bathroom sinks) URINALS MISC(Describe)
• DISHWASHERS
DRINKING FOUNTAINS RAINWATER SYST VACUUM BREAKERS
SHOWERS WATER CLOSETS Iroiey
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
:::•,, .. ...I .. • . •
.. . 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. // ./�
tri j o +4�1 I^. DATE '72-- Z7-c
NAME/TITLE r ^rti L Vl//l�- .
(Signature) (Title)
RELATIONSHIP TO PROJECT D Owner 0 Agent 12-Contractor o Architect o Other
..)a.? —.4,r. —x"to
o NEW o ADDITION o ALTERATION D 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? D YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES 0 NO DEMO PERMIT REQUIRED? o YES o NO
III
Bulletin#100—January 1,2007 Page 2 of 4 k\Handouts\Permit Application