08-101144ciry or i& RECE D
FederralWay 01 _ZLL14
MAR p 6 2008 PERMIT
COMMUNITY DEVELOPMENT SERVICES
SF MF CO ME EL PL DE EN FP
33375 81x AVENUE SOUTH • PO BOX 9718
FEDERAL WAY, FAX
98063-9778 op
FL D L I G A T I O N TD
FEDERAL
WAY,
FAX 753-835-7609
WWW dtvoffetlemlway cum SS WAY
L
The following is required ir;jbDion-an incomplete application will not be accepted. Please print Legibly (in ink) or type.
PROPERTY •, •
SITE ADDRESS(( SUITE/UNIT #
ASSESSOR'S TAX COEL 1f b -j IL LOT SIZE (sj)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page/or lengthy legal descr{ptlon) -
PROJECT• ' •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING 10 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
GZs"sic fz L
PROJECT NAME (Name of Business or Owner Last NamS UC -A ay
PEOPLE•R•
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
NAME
'PRIMARY PHONE
MAILING ADDR S ( C STATE, �ZP� E-MAIL ADDRESS
COMPANY NAME _
�
APPLICANT NAME
OFFICE PHONE
MAILING-ADDRESSSr
CITY, STATE, ZIP
CELL PHONE
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
los 2 31 - 00
° 2 - 3 ( - o y'
(13,5') .3')y
CO RACTOR'S REGISTRATION NUMBER
EXPIRATION DATE
E-MAIL ADDRESS
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other
" ;' 1 OC /-6
f PRIMARY PHONE _ E-MAIL ADDRESS
NAME Per RCW 19.27 095:
Lender Wormation is required if project value exceeds $5,000
MAILING ADDRESS CITY, STATE, ZIP PHONE
PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE VALUE OF PROPOSED WORK
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
SQ. FT.
BASEMENT
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
FIRST
COMPRESSORS
FURNACES
RANGES
SECOND
GAS LOG SETS
_ REFRIG. SYSTEMS
DYES a NO
THIRD
❑ YES
o NO
PLATTED LOT?
ADDITIONAL FLOORS (DESCRIBE)
DEMO PERMIT REQUIRED?
a YES
a NO
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
=STING
PROPOSED
TOTAL
TOTAL EMTIRO Sr
TOTAL PROPOSED sr
TOTAL Sr
"NEW HOMES ONLY*" NUMBER OF BEDROOMS TIMATED SELLING PRICE $
a.--- —f/Wci UJ cUon Iype UI ILUUre w Ue inslauea or relocatea as part of ttus project. Do not include existing fixtures to remain.
MECHAAN7CAL
Value of Mechanical Work $ (A COPY OP 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 (commerd4
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
_ REFRIG. SYSTEMS
BATHTUBS (—Tub/Shower combo)
LAVS (Bathroom Sinks)
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS (Toney
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
NEW ADDRESS REQUIRED?
I cert{fy under penalty of perjury that I am the property owner or authorized agent of the property owner. I cert(fy that to the best of my
knowledge, the h1fbrmation 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:
Authorized Agent
n NEW o ADDITION
o ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY?
a YES ❑ NO
BASIC PLAN?
a YES
o NO
ZONING DESIGNATION
CHANGE OF USE?
a YES
❑ NO
NEW ADDRESS REQUIRED?
DYES a NO
UP/SEPA/SU?
❑ YES
o NO
PLATTED LOT?
a YES ❑ NO
DEMO PERMIT REQUIRED?
a YES
a NO
Bulletin #100 — January 1, 2008 Page 2 of 4 k\Handouts\Pernut Application