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Federal Way
COMMUNITY DEVELOPMENT SERVICES
33325 8TH AVENUE SOUTH • DOX 9718 MAR 0 9APPLICATION
FEDERAL WAY, WA 9806363 .97]8
253-835-2607• FAX 253-835-2609
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The following is required inetp lion -an incomplete application will not be accepted. Please print legibly (in ink) or type.
PROPERTY INFORMATION
SITE ADDRESS I c co- � C cm m Y}S SUITE/UNIT 1i 20
ASSESSOR'S TAX/PARCEL it
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page/or lengthy legal desrnption)
PROJECT• •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
PROJECT
LOT SIZE (sj)
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT NAME (Name of Business or Owner Last Name) -'r(%P Y' 1CozEaak ,
PEOPLE•- •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
NAME
PRIMARY PHONE
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(253) &3 - 1S
MAILING ADD ESS
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CITY, STATEZIP
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E-MAIL ADDRESS
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COMPANY NAME
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PLICANT NAME
OFFICE PHONE
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MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
o Z11
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CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
S . (�:o - /SL-.
W250 9 31 - WE
REGISTRATION NUMBER
EXPIRATION DATE
E-MAIL ADDRESS
1CONTRACTOR'S
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MPANY NAME
APPLICANT NAME
OFFICE PHONE
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MAILING ADDRESS
CITY, STATE, ZIP Q
Y. PS
CELL PHONE
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RELATIONSHIP TO PROJECT
❑ Architect 11 Tenant ❑Agent 0 Other Q Off' TaC-) r
FAX NUMBER
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NAME PRIMARY PHONE E-MAIL ADDRESS
411 1
1 Y1 ( 111
NAME
Per RCW 19.27.095:
Lender information is required gproject value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING ASSESSED/APPRAISED VALUE
PROPOSED USE _KP TCJ.� \
VALUE OF PROPOSED WORK $ 10cj , d O
SPRINKLERED BUILDING? / YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 11 HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
S . FT.
TOTAL
SO. FT.
BASEMENT
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
FIRST
COMPRESSORS
FURNACES
RANGES
SECOND
GAS LOG SETS
REFRIG. SYSTEMS
o NO
THIRD
o YES o NO
DEMO PERMIT REQUIRED? o YES
o NO
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE O CARPORT ❑
NUMBER OF FLOORS
EXISTING
PROPOSED
TOTAL
TOTAL aatsrrxO sr
TOTAL PROPOSED sr
TOTAt sr
""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.
MECHAA7CAL
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 (cmanen laq
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
BATHTUBS (or Tub/Snag combo)
LAVS (Bathroom Sinks)
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS (Poileq
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
UP/SEPA/SU? o YES
I certVy under penalty of perjury that I am the property owner or authorized agent of the property owner. I cert(jy that to the best of my
knowledge, the Wormation submitted in support of this permit application is true and correct. I cert(fy 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 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:
or Authorized
o NEW ❑ ADDITION
o ALTERATION
o REPAIR ❑ TENANT IMPROVEMENT
BUMDING SHELL ONLY?
o YES o NO
BASIC PLAN? o. YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE? o YES
o NO
NEW ADDRESS REQUIRED?
o YES o NO
UP/SEPA/SU? o YES
o NO
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED? o YES
o NO
Bulletin #100— January 1, 2008 Page 2 of 4 Mandouts\Permit Application