09-101797 R E C.;t 1 V I- .� .►of A y
VI-
CITY L. 6( - t 0
Federal Way ,SAY r PERMIT
COMMUNITY DEVELOPMENT SERVICES Z�Qy SF MF CO ME EL PL DE EN FP
33325 D AVENUE SOUTH•
0PO 63-971 9718 CATIONFEDERAL WAY,WA 98063-9718TD253-835-2607•FAX253-8352609 FEDEkPFALI / /
w unu.dt,torrede rat w a a.c o n e
CDS
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS 32. Z.-9 -1S /'1 c - SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# _ ) 7 .. 3, 0- 0 ¶ 3 0 LOT SIZE(sf
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach W P.9.1.,toffy t daaptlo i)
• PROJECT INFORMATION
TYPE OF PERMIT >fl BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed descriptioi of uk included on this ermit onl
(1 1„✓c ) 5,...._ S —}—,, --G—�`.
H
I ^ ` 1 1�^
4-£�-- �-Y \- \ "
^�iPROJECT NAME(Name of Business or Owner Last N)
• PEOPLE INFORMATION
PROPERTY NAM ��� � ��� PRIMARY PHONE
OWNER ,/`� W\ ( )
MAILING ADDRESS CITY,STAT ZIPE-MAIL ADDRESS
'52-52e, it -4- Fe A. Q\
CONTRACTOR COMPA NAM APPLICANTNAME l 1)Cca OFFICE PHONE_ \1 ete.�e--1��� 2� �-Uw\ (253 lcy 5 -ss-4,W
i DS --.F 5 i2,j- -
CIT INGEpERA BU LICENSE NUMBER l EXPIRATION CATEDRESS (qYZE,ZIP �/ FAX NUMBER
( ) -
TT - • / •
CONTRACTOR'S REGISTRATION NUMBER EXPIR¢TION DATE E-MAIL ADDRESS
oK-- ti) \-k. V ( `-) 'e S Al
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMB ER
0 Architect 0 Tenant 0 Agent 0 Other ( )
PROJECT _ NW, f PRIMARY PHONE E-MAIL ADD
CONTACT ✓ tN'ar(FS J L e- -\-Lo 1N\ ( 3)Sri+ - (p 0 G._(nv��'�Q0l,QO \
LENDER NAME + Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
/ �I .—
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WO $ `t' .,J•-
SPRINKLERED BUILDING? o YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQ a NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKERAVEN o RIGHLINE 0 PRIVATE(SEPTIC)
ig PROJECT FLOOR AREAS •
AREA DESCRIPTION EXISTING PROPOSED TOTAL
BASEMENT SQ.FT. SQ. FT. SQ.FT.
FIRST
SECOND ‘
\
THIRD
i
ADDITIONAL FLOORS(DESb BE)
/////77V Z----- _
DECK(0 COVERED OR 0 UNCO RED?)
GARAGE 0 CARPORT 0
maim rza:wta TOTAL TOTAL AasrnYo sr TOTAL PROPOSED Sr TOTAL Sr
NUMBER OF FLOORS
**NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
1.11111111111111111111.111111111111 -IIIIIII ,iriaIIIIIII.MIIIIIIIIIIIIIII
Indicate number of each type of fixture to be installed ortelocczted as part of this project. Do not include existing fixtures to remain.
MECHANICAL
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 WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS H S(commada
COMPRESSORS FURNACES RANG
DUCTS GAS LOG SETS REFRIG.S EMS i
PLUMBING
omN\
BATHTUBS(or Tub/ShowerCombol LAYS(aetu smk� URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(-rode)
ELECTRIC,WATER HEATERS SINKS WASHING MACHINES
HOSE$iBBS SUMPS
SIGNATURE
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 per •n, including the undersigned, and filed against the city, but only
where such claim arises out of the reliance of the including is offi aced employees, upon the accuracy of the formation supplied to
the city as a part oft •'plication.
�7 0
SIGNATURE: IIIL � 4— � �� 1.-'4111.-'411. � � _. � (
y� DATE JPO
_
I .party e• .er. d/or Autho"i Agent
a NEW a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN?
❑YES o-NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU?
a YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100-January 1,2009 Page 2 of 4 k\Handouts\Permit Application