09-1035041
Cl� OF
Fed eralWaECEIV#b
-- -----i
Y PERMIT SF MF CO ME EL PL DE EN(D
333025MMUNITY 8TMAVENUE ,OUTINPOBOX%P 10 2009
FEDERAL W,4Y, 98063-9718 AIN I CATI O N U
253835-2607• FAXX 253-835-2609
�F FEDERAL
The following is requiredCi ation - an incomplete application will not be accepted. Please print legibly (in ink) or type.
SITE ADDRESS of I
ASSESSOR'S TAR/PARCEL #
S
33(0* St.
Z -13--2 1
-
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) -twin Lal-," ShOQ/��1LA-�
(Attach separate page f r leagthy legal description)
SUITE/UNIT #
South I. aqlf, Cue
Approved .0
�rAs Detailed > V
r3 7 ��
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHAN�CXE " --' � --
C U)
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGIN9kRWG O/FIRE PREVENWA UkEW Zi7
PROJECT DESCRIPTION (Provide detailed escriptioof work included on this permit onit4 r
FLA sterns SFS) i I I mods iae. ey-ishn s r�nkl�%
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CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
14 (31 NOD 55" 91- la -al- D°►
FAX NUMBER
(25-2))U -`rho
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE
Sfn'M r� 136 OT �a-31- o R
w�
N
S( rA/ 1 1 / Fire`� � 1 to 1 s Int .
I�pAM,F `� I I l D
(Z,-: OFFICE P) 4(0 -146
�
�P/L�IC�yy��ANT
�i�[
-rw / If/I,DRESS CITY, STATE, il,)A �O T t%
`ELL PHONE
IFAX
Pe(tj0_u
TW 1 n Lakx-s Remodel
PROJECT NAME (Namof Business or Owner
..e
Last Name)
PRIMARY PHONE -
)Per
-WAIL ADDRESS
v,
PEOPLE•
•
PROPERTY
OWNER
NAME
'q04 --WW
Inc. JT/Ore
3�O
PRIMARY PHONE
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
^' I /W r� � � f` -
I ADDRESS ���� •
CITY, STATE, P E-MAIL ADDRESS
4rqzp
COMPANY NAME
Srni+h Fre S tro
PLICANT NAME
�er-cA Taino D
OFFICE PHONE
( 2763) qa4 - IM
MAILI/0
6 NG RESS 'I�M I^ve E
Cf7Y, STATE, ZIP^ oo yq},
L'l-
(ELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
14 (31 NOD 55" 91- la -al- D°►
FAX NUMBER
(25-2))U -`rho
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE
Sfn'M r� 136 OT �a-31- o R
E-MAIL ADDRESS
fti tIC
S( rA/ 1 1 / Fire`� � 1 to 1 s Int .
I�pAM,F `� I I l D
(Z,-: OFFICE P) 4(0 -146
.1,
% `�✓ -f �Y�. 4
�P/L�IC�yy��ANT
�i�[
-rw / If/I,DRESS CITY, STATE, il,)A �O T t%
`ELL PHONE
IFAX
RELATIONSHIP TO PROJECT /
❑ Architect ❑ Tenant ❑ Agent �( Other
NUMBER _
(ZG3 ) qZ -Z3,56
/ I
� NAME
PRIMARY PHONE -
)Per
-WAIL ADDRESS
NAME RC1 19.27.095:
— - _ in ormat' Jproject value exceeds $5,000
MAILING ADDRESS _ _ _ - - . STATE, ZI PHONE
EXISTING USE C D h(1rA D 1q�K Cx+ PROPOSED USE C(�,�111/1'1'1111Li
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ in IQ
SPRINKLERED BUILDING? VYES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
ire. &W
Ka
I
AREA DESCRIPTION
EXISTING
Sq. FT.
PROPOSED
S . FT.
TOTAL
SQ. FT.
BASEMENT
GAS WATER HEATERS MiSC (Describe)
BOILERS
FIREPLACE INSERTS
FIRST
COMPRESSORS
FURNACES
RANGES
SECOND
GAS LOG SETS
REFRIG. SYSTEMS
NEW ADDRESS REgUIRED? o YES o NO
THIRD
o NO
PLATTED LOT? o YES o NO
DEMO PERMIT REQUIRED? a YES
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
extsru+o
PROPOSED
TOTAL
--SF
TOTAL PROPDSFD SF
TOTAL SF
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
■ FIXTURES
Indicate number of each type offUture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work $ (ACOP OF BID OR ESTIMATE MUST BE INCLUDED WITH APRUCA77ON)
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS PIPE OUTLETS WOODSTOVES
BBQS
FANS
GAS WATER HEATERS MiSC (Describe)
BOILERS
FIREPLACE INSERTS
HOODS (Commercial)
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
BATHTUBS (or7Lb/Shower Combo)
LAVS (Bathroom Sinks)
URINALS MISC (Descrlbe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS rrotlet)
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
o NO
1 certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the best of my
knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with all applicable
City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the issuance of this permit
does not remove the owner's responsibility for compliance with local, state, orfederal laws regulating construction or environmental laws.
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, 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 apart of this application.
SIGNATURE:
Authorized
FOR OFFICE USE ONLY
o NEW a ADDITION
o ALTERATION
❑ 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 REgUIRED? o YES o NO
UP/SEPA/SU? o YES
o NO
PLATTED LOT? o YES o NO
DEMO PERMIT REQUIRED? a YES
o NO
Bulletin #100 -January 1, 2008
Page 2 of 4
MandoutsTermit Application