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07-102953Federal Way , t �Z- ''I Y PERMIT P COMA. 'N1TY DEVELOPMENT SERVICES MF CO ME EL PL DE EN 333258^AVENUE SOUTH • PO BOX 9718 FEDERAL WAY, FAX 98063-9718 ion p p L I C AT I O N TD / .253-8352607• FAX 253-835-2609 Q / - icww.rilyuffedemlwnu.cnm NW The following is 64 fflired info, then - an incomplete application will not be accepted. Please print legibly (in ink) or type, _ rUUtt SITE ADDRESS r011 1111 111 )(/ ,SUITE/UNIT # ASSESSOR'S TAX/PARCEL # ! _ 0 LOT SIZE (sfl LEGAL DESCRIPTION (e.g. Acme Estates, Lot I) (Attach separate page for Iengthy legal d—ripfian) TYPE OF PERMIT ❑ BUILDING O PLUMBING 9AECHANICAL r��, ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ff FIRE PREVENTION SYSTEM PROJECT NAME (Name of Business or Owner Last Name) PROPERTY OWNER CONTRACTOR COPY of evd regalred with each aVpH..tlon APPLICANT PROJECT CONTACT LENDER EXISTING USE 7.�. PEOPLE INFORMATION NAME PRIMARY PHONE MAILING ADDRESS - CITY, STATE, ZIP E-MAIL ADDRESS OMPANY NAME ! ` APPLICAN NAME OFFICE PHONE L4 TI Leto CI , ST ZIP CELL PHONE F ER CJTY OF FEDERAL WAY BUSINESSENSE� ' EXP TIO DAT 0 ,A Ah _ EXPIRATIO AT� CON CTOR' REC WEE E-MAIL ADDRESS CO ANY NAME - APPLICANT NAME OFFICE PHO E MAILING ADDRESS - CITY, STATE, ZIP CELL PHONE RELATIONSHIP TO PROJECT FAX NUMBER 13 Architect o Tenant ❑ Agent ❑ Other NA RR _ E-MAIL ADDRESS NAME Per RCW 19,27.095: Lender information is required if project value exceeds $5,000 MAILING ADDRESS CITY, STATE, ZIP /PHONE EXISTING ASSESSED/APPRAISED VALUE $_ SPRINKLERED BUILDING? %LYES ❑ NO WATER SERVICE PROVIDER ❑ LAKEHAVEN SEWER SERVICE PROVIDER ❑ LAKEHAVEN PROPOSED USE VALUE OF PROPOSED WORK $ © D FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED? YES ❑ NO O HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) ❑ HIGHLINE 0 PRIVATE (SEPTIC) 1 AREA DESCRIPT N EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL SQ. FT. a ASEMENT /y lJ�� BBQS FANS GAS WATER HEATERS MISC (Describe) FIRST FIREPLACE INSERTS HOODS )cmnmerdal) COMPRESS S SECOND / l!�' RANGES DUCjS, GAS LOG SETS THIRD PLUMBING BATHTUBS torrub/Showercombo) LAVS Wa4uoom Sinks) URINALS MISC (Describe) ADDITIONAL FLOORS (DESCRIBE) RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS DECK (❑ COVERED OR ❑ UNCOVERED?) WATER CLOSETS rroneq ELECTRIC WATER HEATERS SINKS GARAGE ❑ CARPORT ❑ HOSE JBIBBS _ 1 SUMPS NUMBER OF FLOORS rM ING PROPOSED 7orAL TOTAL E[ISTINO Sr 7.OTAL PROPOSED SI 7L Sr 0TA "'`NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ Indicate number of each type of future to be installed or relocated as part of this project. Do not include existing futures to remain. MECHANICAL • Ut/ Value of Mechanical Work $ (ACOP OF BID OR EST TE MUST BE INCLUDED WITH APPLICATION) AIR HANDLING UNITS EVAPORATIVE COO 5 GAS PIPE OUTLETS WOODSTOVES BBQS FANS GAS WATER HEATERS MISC (Describe) BOILERS FIREPLACE INSERTS HOODS )cmnmerdal) COMPRESS S FURNACES RANGES DUCjS, GAS LOG SETS REFRIG. SYSTEMS PLUMBING BATHTUBS torrub/Showercombo) LAVS Wa4uoom Sinks) URINALS MISC (Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS OWERS WATER CLOSETS rroneq ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE JBIBBS _ 1 SUMPS 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 r ,/ DATE�� RELATIONSHIP TO PROJECT ❑ Owner O Agent ❑ Architect ❑ Other o NEW [iADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT. BUILDING SHELL ONLY? o YES ❑ NO BASIC PLAN? o YES o NO ZONING DESIGNATION CHANGE OF USE? o YES ONO NEW ADDRESS REQUIRED? ❑ YES o NO UP/SEPA/SU? ❑ YES o NO PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO Bulletin #100 —January I; 2007 Page 2 of 4 k\Handouts\Permit Application