07-101567arr of -
Federal Way p ► PERM 1
COMMUN17Y DEVEWPMENT SERVICES MArj n j�SF MF CO ME EL PL DE EN FP
33325 8^t AVENUE SOUTH • PO BOX 9718 �R( ` i*P11
�� A �7-�FEDERAL WAY. WA 98063-9718 ((-],PTA 1 253835-2607• FAX 253-835-2609 p�
u'�+><+. cittioireder[dttY[U,ctir_i ^{N O`+ FFM ,.
vi`��pI(�4 DEPT.
The following is required i rmation - an incomplete application will not be accepted. Please print legibly (in ink) or type.
PROPERTY, • •
SITE ADDRESS 3q`'1 to 164" Ave Say ��\ SUITE/UNIT # l7
ASSESSOR'S TAX/PARCEL # Z. 1 Z l D N - —.i 3 t= LOT SIZE (si)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page (or len_q ft legal description)
PROJECT• •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ,
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING N( FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this vermis only)
RA k Frrc, �QetrdaLrs Ari �,X4\zmh , _S`Lat\ S4syeM t.t
PROJECT NAME (Name of Business or Owner Last Name)
PROPERTY
OWNER
CONTRACTOR
COPY of card required
with each application
APPLICANT
PROJECT
CONTACT
LENDER
NAME UC ^- /.! u•
PRIMARY PHONE -
l`E-MAIL
MA[LZG .37DO �e��{MAJIWc.Jf{�W`
,'IwI STATE, �M WA Claw
ADDRESS
C PANY NAME
c„�-C'a� V-4re ?%Zok&'N
PLICANT NAME
Fagbe
OFFICE PHONE
(Z53)gz(.-22.(,)o
MAILING ADDRESS
270-1 Zoe Avc, E
CnY, STATE, ZIP
Tcw,v,., uA CAZ4
CELL PHONE
( ) -
CnY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
(M) 9L2_ -l019s
CQiII"li2tltTO SREGISTRATION NUMBER
EXPIRATION DATE
E-MAIL ADDRESS
CO�j PANY N`� E
1", �C'. 'r; re- Nz. -r_�Zn
AMLICANT NAME
L06b Po191a
OFFICE PHONE
( 2S3 ) ZS LI _�SHa5
MAILING ADDRESS
CITY, STATE, ZIP tj
CELL PHONE
RELATIONSHIP TO PROJECT
Agent Other
FAX NUMBER
( 2_15 J) 7-0.41 -3Hv 6
❑ Architect ❑ Tenant ❑ ❑
NAME PRIMARY PHONE E-MAIL ADDRESS
�ob �o tsb,_r (25,J)
Zia (4 -3 4 asI low �a Jr o ) Gm . "m
NAME
Per RCW 19.27.095:
Lender information is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING USE _ kr I 1
EXISTING ASSESSED/APPRAISED VALUE $
SPRINKLERED BUILDING? YES E NO
/
WATER SERVICE PROVIDER Gf LAKEHAVEN
SEWER SERVICE PROVIDER n LAKEHAVEN
PROPOSED USE
SY�cwtc�.�•
VALUE OF PROPOSED WORK $ 7$00
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? DYES n NO
HIGHLINE ! TACOMA i i PRIVATE (WELL)
Li HIGHLINE PRIVATE (SEPTIC)
,FLOOR
AREA D
_
BASEMENT
FIRST
EXMI _ G
SQ. FT.
GAS PIPE OUTLETS WOODSTOVES
BBQS
PROPOSED
SQ. FT.
TOTAL
SQ. FT.
BOILERS
FIREPLACE INSERTS
HOODS (Commerofai)
COMPRESSORS
FURNACES
RANGES
SECOND
GAS LOG SETS
REFRIG. SYSTEMS
❑ NO
THIRD
❑ YES ❑ NO
UP/SEPA/SU? ❑ YES
❑ NO
ADDITIONAL FLOORS (DESCRIBE)
❑ YES ❑ NO
DEMO PERMIT REQUIRED? ❑ YES
❑ NO
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
ensTRcc
PROPOSED
TOTAL
7O7ALERlSTTNGSF
TOTAL PROPOSED SF
rorwcsP
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
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 (Commerofai)
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
PLUMBING
BATHTUBS (or Tub/Shower Combo(
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
LAVS (Bathroom Sinks) URINALS MISC (Describe)
RAINWATER SYST VACUUM BREAKERS
SHOWERS WATER CLOSETS (Triiet)
SINKS WASHING MACHINES
SUMPS
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
u
(Signature)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent
Pry
Contractor
1 I Lh.A r DATE MWOk 3 ZLY�7
(Title)
❑ Architect ❑ Other
FOR OFFICE USE ONLY
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR (i TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES ❑ NO
BASIC PLAN? ❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE? ❑ YES
❑ NO
NEW ADDRESS REQUIRED?
❑ YES ❑ NO
UP/SEPA/SU? ❑ YES
❑ NO
PLATTED LOT?
❑ YES ❑ NO
DEMO PERMIT REQUIRED? ❑ YES
❑ NO
Bulletin #100 — January 1, 2007 Page 2 of 4 k\Handouts\Permit Application