04-101859C" of
Federal Way RECEIVW PE,
R M I_T
COMMUA77Y DEVELOPMENT SERV/CES
33530 FIRST WAY SOUTH • BOX 9718 AY 1 3 APPLICATION
FEDERAL WAY, WA 98066 3-9718
253-6614115- FAX 25366/4129
toww.cituolrederaltoau mm
CITY OF FEDERAL WAY
The following's requii`Mk ply T6 In incomplete application will not be
SF MF CO ME EL PL DE EI�Y
Please
SITE ADDRESS ab/- CNc �a� e 1, SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # p� Q - �' U a LOT SIZE (s.)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
or
(Attach separate page for IeVhy legs( desorption)
N.
r
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING 4'FfRRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Prouide detailed description of work included on this permit onlu)
rA t J -,D z
PROJECT NAME (Name of Business or Owner Last Na e)
PROPERTY rz—
OWNER� �� �� 1Y3 .-,x
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
0
70RMT10N
PRIMARY PHONE
CITY, STATE, ZIP
�COMPANY NAME
Ps �� s lZihb co
OFFICE PHONE
(,-/.) r- )d?I
APPLICANT NAME
GC5a
OFFICE PHONE
CITY, STATE, ZIP
I-)c-�� 4c.49-- 9A d'`L
MrCi ADDRESS
,j- &>L
-60 S'9
CITY, STATE, ZIP
ec? �Z�
'CELL PHONE
(o7aG ) 6�
_6,6r
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
_-B
L /oc
(ya6137�j
CONTRACTOR'S REGISTRATION NUMBER (copy of card
I/)-
required with each application)
r7
EXPIRATION DATE
e !i e- 1` C I S -
n
COMPANY NAME APPLICANT NAME
c o� w �c`vw� �� T,�•�/r��.�
OFFICE PHONE
(,-/.) r- )d?I
-ryas /
MAILING ADDRESS
a- !Sc
CITY, STATE, ZIP
I-)c-�� 4c.49-- 9A d'`L
CELLPHONE
�pj G ) 6SZ
-60 S'9
RELATIONSHIPTO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent
W,15-th—er (Describe)—Ly-*
PRIMARY PHONE E-MAIL ADDRESS---]
�r b k- tic -5 �e r�u (Zo6 ) 40, - 6 d�'� AD
Per RCW 19.27.095: Lender information is NAME
required if project value exceeds $5,000
MAILING ADDRESS CITY, STATE, ZIP
EXISTING ASSESSED/APPRAISED VALUE $
SPRINKLERED BUILDING? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN
SEWER SERVICE PROVIDER ❑ LAKEHAVEN
PROPOSED USE
VALUE OF PROPOSED WORK $ 1, �O' �Q
r /�
FIRE SUPPRESSION SYSTEM PROPOSED QUIREWYE^ S ❑ NO
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
EXISTING S F f.
PROPOSED SQ. FT.
TOTAL
BASEMENT
o ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
FIRST
BASIC PLAN? o YES
o NO
ZONING DESIGNATION
SECOND
CHANGE OF USE? o YES
❑ NO
NEW ADDRESS REQUIRED? o YES o NO
THIRD
❑ NO
PLATTED LOT? o YES o NO
DEMO PERMIT REQUIRED? o YES
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS?
TOTAL ERISTDIG
TOTAL PROPOSED
TOTAL ERISTDIG MD PROPOSED
"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
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
PLUMBING
BATHTUBS (orTubtSb—rcombo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS (comm« w)
RANGES
GAS WATER HEATERS
WATER CLOSETS Roaeq
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
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. t
NAME/TITLE �u-mac-� DATE � —) / J"l
(Stpaturel V t1 i
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ,.tractor ❑ Architect ❑
FOR OFFICE USE ONLY
o NEW ❑ ADDITION
o ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑ YES o NO
BASIC PLAN? o YES
o NO
ZONING DESIGNATION
CHANGE OF USE? o YES
❑ NO
NEW ADDRESS REQUIRED? o YES o NO
UP/SEPA/SU? o YES
❑ NO
PLATTED LOT? o YES o NO
DEMO PERMIT REQUIRED? o YES
❑ NO
Bulletin #100 — March 30, 2004 Page 2 of 4 k\Handouts — Revised\Permit Application