07-101699CIFYDF
Federal way PERMIT - -
COMMUNITY DEVELOPMENTSERVIC EG SF MF CO ME EL PL DE E FI
33325' AVENUE TH • SOUBOX 9 T°
FEDD ERAL WAY, WA 9806363 /
-9718 APPLICATION
.253-835-2607• FAX 253-835-2609 / -
Dn�ivacilUnlfcdemhumrcanr
The following is required inform tY "complete application will not be accepted. Please print legibly (in ink) or type.
91 - r.1: FE- -.-r In
SITE ADDRESS7 7' �6 � 4 le SUITE/UNIT # f
ASSESSOR'S TAX/PARCEL #S tj _ 062-4— k- - LOT SIZE (s)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach sepmate Pnge far lengthy legal d—iptionl
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION id ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of workincluded on thi permit only
Z.
PROJECT NAME (Name of Business or Owner Last Name) L., -))p TAUL
•' • •
PROPERTY
OWNER
OC ONTRACTOR
COPY of cvd required
with each appllcatlon
APPLICANT
PROJECT
CONTACT
NAME
PRIMARY PHONE
MAILING ADDRESS
-
0 0 4K,97- z � iZA
CITY STATE, ZIP
�►
E-MAIL ADDRESS
COMPANY NAME
-.-/�
M 1 G
_ A�ICANT NA
OFFI�CaE�PHO�Nj,E g //�
D ESS
,�� 3v
CITY, STATE, IP
l N►
09 S
CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE
NUMBER
DATE
_
FAXNUMBER
9.(0 � q 5( -"r) "
CONTRACTOR REGISTRATION
jt;A1FITION
J(_ 31
0
X2,3 )� biz
S NUMBER
ox L - 2�8 P4
EXT T10
DAT
"8
E-MAIL ADDRESS
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Al
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RELATIONSHIP TO PROJECT n1�
❑ Architect ❑ Tenant o Agent 'Other}Irl f^l�/IM roytA .e7yA
G
Rra 6A.,
z 0 ) 9�3 -72 s- I
CELLPHONE
FAX NUMBER
�s ) 05-4/
E-MAIL ADDRESS
AREA DESC ON
EXISTIN
SQ; FT.
PROPOSED
SQ. FT.
TOTAL
SQ. FT.
BASEMENT
RAINWATER SYST
DRINKING FOUNTAINS
SHOWERS
FIRST '
SINKS
HOSE BIBBS
SUMPS
SECOND
ZONING DESIGNATION
CHANGE OF USE? ❑ YES
THIRD
NEW ADDRESS REQUIRED?
❑ YES o NO
UP/SEPA/SU? o YES
ADDITIONAL FLOORS (DESCRIBE)
PLATTED LOT?
❑ YES o NO
DEMO PERMIT REQUIRED? ❑ YES
DECK (O COVERED OR ❑ UNCOVERED?)
GARAGE O CARPORT El
NUMBER OF FLOORS
EXISTING
PROPOSED
TOTAL
TOTAL FJaSTINO ST
TOTAL PROPOSED ST
TOTAL ST
—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.
MECHANICAL
Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS
BBQS FANS
BOILERS FIREPLACE INSERTS
COMPRESSORS FURNACES
DUCTS_ GAS LOG SETS
PLUMBING
t,
BATHTUBS (or Tub/Sh—rcombo)
LAVS (13.0uoom Sinks)
DISHWASHERS
RAINWATER SYST
DRINKING FOUNTAINS
SHOWERS
ELECTRIC WATER HEATERS
SINKS
HOSE BIBBS
SUMPS
GAS PIPE OUTLETS WOODSTOVES
GAS WATER HEATERS MISC (Describe)
HOODS )commercial)
RANGES
REFRIG. SYSTEMS
URINALS MISC (Describe)
VACUUM BREAKERS •
WATER CLOSETS Irouel)
WASHING MACHINES
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 flied against the City of Federal Way, but only where such claim
arises out of the reliance of tcity, including its officers and employees, upon the accuracy of the information supplied to the city as a part of
this application. -77.1
NAME/TITLE
RELATIONSHIP TO PROJECT
❑ Owner ❑ Agent 1 Contractor ❑ Architect ❑ Other
TE rl . 2 —Q -7
+ .a zF[�aaQ)a
t,
o NEW o ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES ❑ NO
BASIC PLAN? o YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE? ❑ YES
❑ NO
NEW ADDRESS REQUIRED?
❑ YES o NO
UP/SEPA/SU? o YES
❑ NO
PLATTED LOT?
❑ YES o NO
DEMO PERMIT REQUIRED? ❑ YES
o NO
T 01: Jai# � ►G J l •_5. =Iffy { lo.d.�p — 2St `S'a •
Bulletin #1100 — January ); 2007 Page 2 of 4 k\Handouts\Permit Application