07-102906 I.
RECEIVE?. •
CITY OF A / J a - c 0 ` `1 RD
Federal Way �{���(y PERMIT 4V-ri
COMMUNITY DEVELOPMENT SERVICES 3 0 20o7 SF MF CO ME EL PL DE EN6P
3332FED AVENUEsemi98POB71 97I8 pLI CATI ON
FEDERAL WAY,WA 98063-97T1y8 7D -----------a
253-835-2607•FAX 253-8f Tai OF FEDERA
wuw.ciluoffederalwau.cont BUILDING DEPT.
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
j • PROPERTY INFORMATION
SITE ADDRESS_ ��y l 0 1 Ill Ave- 5_ SUITE/UNIT#_ I L' J
ASSESSOR'S TAX/PARCEL# 2 O O el o - ® O o LOT SIZE (s/)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) 120 U Y)Ok TZ b 1 e 8133 C1
(Attach separate page(ar lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
0 DEMOLITION Cl ELECTRICAL 0 ENGINEERING XFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
:_i_r1Satl la 11orl o1- 0.. Iii., lro rv)e vvi 300 F re Su pIpso sS ) c0
5y5 fie m
PROJECT NAME(Name of Business or Owner Last Name) 0-6 L(Yl GI 17(x lot e P13 3 a-
• PEOPLE INFORMATION
PROPERTY NAME �1 APRIMARY PHONE
OWNER VnOyrLAt-
P_ 4 c.Q!_ ( ) -
MAILING ADDRESS CITY.STATE.ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
iQ ?IT Wood c Duel-, Svc 14-r1Sten fluIcileoer ( at0 1-0(1) -0ci
MAILING ADDRESS CITY.STATE.ZIP CELL PHONE
(�i00 Iat Pro. 3 . 5ectttie W 98148 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIi'2ATION DATE FAX NUMBER
19 - 6 -- 16 55 91 - 00 - is ( ) -
COPY of card re d: CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
PY cittior `+ 1 7fQ�] (/�� 1
with_h a Sfcatio 1 1 C'o ) �k- o V b c V I Q / i /
APPLICANT l' COMPANY NAME APPLICANT NAME OFFICE PHONE
Same Ce5"';{�c, ( ) -
MAILING ADDRESS CITY,STATE.ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT ' - ' FAX NUMBER
❑ Architect 0 Tenant 0 Agent 0 Other ( ) -
PROJECT NAME PRIMARY PHONE 1 E-MAIL ADDRESS
CONTACT ie-r-1`,3 fiC%Yl (fl I C`kioi'1 e)-- (tel J) 1A�C- - Gc1-1 6
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE.ZIP PI IONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 1 i 0 45-0 civ
SPRINKLERED BUILDING? 0 YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN D HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE i) PRIVATE(SEPTIC)
• PROJECT FLOOR AREAS
AREA DESCRIPTION_.._,___ EXISTING _. PROPOSED
TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR 0 UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS ERISTmG PROPOSED TOTAL TOTAL=STEW 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$ (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(commerriai)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS IorTub/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS rani)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS 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 �I(/ / '(✓( L- - DATE 5/30 `a60-9-
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent CI(Contractor 0 Architect ❑ Other
FOR OFFICE USE ONLY
o NEW n ADDITION ❑ALTERATION r REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES ❑NO
NEW ADDRESS REQUIRED? c YES c NO UP/SEPA/SU? o YES o NO
PLATTED LOT? u YES ❑NO DEMO PERMIT REQUIRED? ❑YES u NO
Bulletin#100-April 2,2007 Page 2 of 4 k\Handouts\Permit Application