08-104271 �� 747 fv - 4_,;2_ __
'v ' ERMIT — —
COMMUNITY DEVELOPMENT SERVICES SEPgzollaSF MF CO ME EL PL DE EN
33325 11"AVENUE SOUTH•PO BOX 9718
FEDERAL WAY,WA 98063-9718 WA;A.TION TD
253.835-2607•PAX 253-835.2609.� CITYC�� F
The following is required informatroasSn incomplete application will not be accepted. Please print legibly(in ink)or type.
1, • PROPERTY INFORMATION
SITE ADDRESS 32.12q 1 ` / SU^ May S S . SUITE/UNIT# Dr)
ASSESSOR'S TAX/PARCEL# ._- __ _ LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
rand%+ gePI/6r bWeW legal damtPdanl
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING K FIRE PREVENTION SYSTEM
PROAMDE8,T ION(Provide detailed description of work on this permit only)
7� S
PROJECT NAME(Name of Business or Owner Last Name) U9 PN\r Force--
II
PEOPLE INFORMATION
PROPERTY NAME . PRIMARY
PHONE
OWNER ccadS)- o Ter/o./-e_ 2.JLLC ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
212q We vsrr We./ s. fed. may, VA'
CONTRACTOR MPANY NAMECANT NAME OFFICE PHONE
LINO D *PIr-e, ?rot. Jess)CCiO ) iS0/ (4eS10ELL N�fffl -7 7'
OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION D TE FAX NUMBER
IC°q . DStO) D -0L--- )2 N NUMBER 31, (E'ai1 -go s( ADDRESS
CaOvJ Wrc190‘A\A1 L- 1.4 s$EPI }e551CaO_Ctow prom
APPLICANT COMPANY NAME C APPLICANT NAME / OFFICE PHONE)
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
a Architect a Tenant a Agent a Other PRIMARY ( ) -
PROJECT Y1 prbeA (f!tJ)Hq E - \jalx ter.rowN-(f•COM
CONTACTMAIL AlIDRESS
� - ��
LENDER NAME Per RCW 19.27.095:
Lender information is required if protect value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZAP PHONE
• ( )
�
1O ((��■ DETAILED BUILDING INFORMATION 1
EXISTING USE J ,1 1 nc-f- '-Q_. PROPOSED USE \1 I (C�
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ \ tl otp.
SPRINKLERED BUILDING? /IefE8 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? _OYES 0 NO
WATER SERVICC PROVIDER 0 LAKEHAVEN a HIGHLINE 0 TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAKEHAVEN a HIGHLINE a PRIVATE(SEPTIC)
■ PROJECT FLOOR AREAS
•
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
•
SECOND •
•
THIRD
ADDITIONAL FLOORS(DESCRIBE)
•
DECK(0 COVERED OR 0 UNCOVERED?)
•
GARAGE 0 CARPORT 0
NUMBER OF FLOORS ZEISTOSE PROPOSED TOTAL TOTALsemnm Al ro'''c rs°r°'s°sr TOTAL sr
•
"!NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
•
al FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECEAMCAL
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 tc.mmaaq
COMPRESSORS FURNACES RANGES •
DUCTS. GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/shower Combo) I.AVS re"mr".m share URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(roam •
- ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify under penalty of perjury that I am the property owner or authorised agent of the property owner.I certify that to the best of my
knowledge,the information submitted in support o f 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 authorised 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. �q
SIGNATURE: I ��/ ./l/ DATE 9/(/ 08:3-
Property
8Property Owner and/or Authorized Agent
•
a NEW a ADDITION a ALTERATION a REPAIR o TENANT IMPROVEMENT
BUILDING 5 L ONLY? o YES a NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? a YES o NO
NEW ADDRESS REQUIRED? a YES o NO UP/SEPA/SU? o YES a NO
PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—January 1,2008 Page 2 of 4 k\Handoutaermit Application