09-101246ciry OF -A
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MMMUIM DEVELOPMENT SERVICES PERMIT SF MF CO ME EL PL DE E FP
J 333 �L� �F AX 9718 K o � "APPLICATION CATI O N
FEDERAL WAY, WA 98063-9718 O2_1,3-83 /
60
www.dtyo/Tederafwnu com
F FEDERAL WA"t
The following is r*qu&m i efy4lation —an incomplete application will not be accepted. Please print legibly (in
ink: or type.
SITE ADDRESS -319'
ASSESSOR'S TAR/PARCEL # 0 / al c
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
PROJECT INFORMATION
SUITE/UNIT #
LOT SIZE (s])
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Prouide detailed description of work included on this aermit onlu) I _
Z/ L&a
PROJECT NAME (Name of Business or Owner Last Nam el 15�1 �l0/y 6)U&
PEOPLE•- •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
lk PROJECT
CONTACT
LENDER
EXISTING USE
/�/� / rtuMAKi YttVIY L'
'MAIL I G D
3/ L� CITY, STATE, Z(P E-MAIL ADDRESS
E�,4C, w� Lig
COMPANY NAME
Ae�,Vtl/7C, Qlel
OFFICE PHONE
OFFICE PHONE
/4/'< <
/z'o
MAILING ADDRESS
Z(
CITY, STATE, ZIP
LZA
CELL PHONE
G[IY OF FEDERAL WAY LICENSE NIjMBE
EXPIRATION DATE
FAX NUMBER
CD OX'S REGI ON NUMBEW
9s`ind�
EXPIRATION DATE
9- -X�
E-MAIL ADDRESS
COMPANY NAME APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
13 Architect ❑ Tenant ❑ Agent ❑ Other
FAX NUMBER
PRIMARY PHONE -MAIL ADDRESS
NAME Per RCW 19.27.095:
Lender information is required if project value exceeds $5,000
MAILING ADDRESS CITY, STATE, ZIP PHONE
PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ `� i ez '
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER 0 LAEZHAVEN ❑ HIG13LINE 0 PRIVATE (SEPTICI
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
SO. FT.
BASEMENT
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
FIRST
COMPRESSORS
FURNACES
RANGES
SECOND
GAS LOG SETS
REFRIG. SYSTEMS
❑ YES ❑ NO
THIRD
❑ YES
❑ NO
PLATTED LOT?
ADDITIONAL FLOORS (DESCRIBE)
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
�a'r0<O
rROeoe60
TOTAL
m
rarer smw ar
TOreL PROMS= Sr
TOTec sr
"NEW HOMES ONLY"' NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fEcture to be installed or relocated as part of this project. Do not include extisting 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 (commm, i4
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
BATHTUBS (or Tub/shaver Combo
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
LAVS(BathroomSint#
URINALS DSC(Descrg )
RAINWATER SYST
VACUUM BREAKERS
SHOWERS
WATER CLOSETS (Poaq
SINKS
WASHING MACHINES
SUMPS
ZONING DESIGNATION
I 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, or federal 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 Phe reliance of the city, including its officers and employees, upon the accuracy of the information supplied to
the city as a part of this appl n. �"
SIGNATURE:
Property Owner and/or Authorized
❑ NEW ❑ ADDITION
❑ ALTERATION
o REPAIR ❑ 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 o NO
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
Bulletin #100 — January 1, 2009 Page 2 of 4 k\Handouts\Permit Application