07-104642 ' ' �t�
T1��i�� �
` �� � _ � � -
Feder way pERMIT � � Z
AUG 2 2 2007 1 SF MF CO ME EL PL DE EN �
COMMUNITY DEVE(APMENT SERVICES
33325 S"�A VENUE SO[IfH•PO BOX 9718 ��L I C ATI O N
ee�eRacwnr.wa ssoss�jl�"y OF F'EpER
253-835-2607•Fa�cas�-s�s-zsosBUILDING D � ���`�- 'I
mww.ciWo�fedcratwau-coni EPT, �1 �'�
TheJoilowing is required information-an incomplete application will not be accepted. Piease print legibty(in ink)or type.
• • � i • • •
SITE ADDRESS �.._�I c� � � �%"�L�F�L �t"i�`i����,{ f� SUITE/iJTTIT#_��1
ASSESSOR'S TAX/PARCEL# ��Z—� v�- t � �� LOT SIZE(s�
LEGAL DESCRIPTION(e.g.Acme Esta[es.Lot 1) c.`''.��i Tz-i'} (�,-` `k� � .`. L � ' ��r}(�,�" �_, <�`<�.r7"�li (,'2�'�(„'��
t i�,
F9ttoch separa[e page for le�g��y leqd descr(ptioN �
' • • ' �
TYPE OF PERMIT ❑BUILDING ❑ PLUMBING ❑ MECHANICAL �`��}�'�"'���
❑ DEMOLITION ❑ ELE(,'TRICAL ❑ ENGINEERING �FIRE PREVENTION SYSTEM
r �
PROJECT DESC ION(Provide detailed description of work included on this permit onlul
'�'�'� �.� � �� � F ��> r f�!:'��'�,'i1 )���Z-i ;l�`tT-1'�,�.:- i��',��C°��`_> ��'�' �''�-.€l`#��' ��,Tt�--(�
j_ l , -.J L �P�r j 4 t .lL,:��1..��.�C � �'_��L..1'��-'t`f i`` ii����.�L �'�; �.•� (�.� °� a�.,'`�i`�t-.� i')r�r�'.�r!:��,
� ' �i. ' 'i,�'i[�'i 4•i � t:�;,���
�""c I/�1, (_f 4-G.,. �- �'�
� : � ..0 1
PROJECT NAME(Name of Business or Owner Last Name) �`<'._14_,' a�.�' �'3'L?`rl--%�-
� • 1 • • •
PROPERTY �'AME PRIMARY PHONE
OWNER ��� � � -
MAILING ADDRFSS CI"IY.STATE.ZIP E-MAIL ADDRFSS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
., ,,, �� -. . , , ;. ,
, - ,
_.
(�i.' '.kf'�;? ;t_i -.'C 7,?.', l I.s i C..__ f:�,�`.' %"t� :f�,. ��' t�(u�-• �
< �� �
MAILING ADDRESS CITY.STATE.ZIP CELL PHONE
� � I_^ �� � ���:
�.�.-��.:L` '�`.,w�k-.� ,�'�� 1\- . �,:.':�ITt.` u�,.1- �3 (.��.�� �-;�t�� � =S j�� - i
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
t> C� �u ' I��� �i :.� I' : (��.=) ',E,S - �{��1
CONTRACT'OR'S REGISTRA770N NUMBER�� �� EXPIRA110N DATE E-MAILADDF2FSS
COPY of eard nqWrcd
alth eaeL appLe.Uon � � ) � ls�.�r � �� �` , i ' ��V
�:C'���F� � � _J . ) `� i �
APPLICANT COMPANY NAME APPLICANC NAME , OFFiCE PHONE
_ • , �v
� ;, � „,,:t,., _ . _ ,.
f�l- ,'l�f;a% �.C; f t.:. t�`r 1���t act. �,.; . }�(a� �..1' �� l`� ) `f: t.=-.,C'i:;
MAILING ADDRFSS CI'IY.STATE,ZIP CELL PHONE
— Y , ._. _� , � 4. . � f .ZG
;�•�i�� .3�.+ �k'__.:��" ;�'��`, t0, t.,t.�. [1��.L. s,.. . Ic.�� �_., �) �-{`�C — `�`Z��:
RELATIONSHIP TO PR0.JECT � / FAX NUMBER
❑ Arehitect ❑Tenant ❑Agent �Ci Other �_C,��k �C:��E' ( �� i*,� (�f�=; � �i�� -,,��i �
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
COPiTACT ' `C`s`-�` , T�� �-�i,'(;,) ���Z: - !��j(i'{ 1L�+c..�i;`in C�E-il�:r.;t.C4yd�.<.�D�:
LENDER NAME Per RCW 19.27.095:
Lender information is required iJ project value exceeds$5,000
MAILING ADDRFSS CITY.STATE,ZIP PHONE
� � -
� � : � 1 1 • ' •
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ I / 4�,�• " `�`
SPRINKLERED BUII,DING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REgUIRED? ❑YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN � HIGHLINE ❑ PRIVATE(SEPTIC)
l�:
• . . . -
_ _
AREA DESCRIPTION EXISTING PROPOSED TOTAL
S .FT'. S .FT. S .FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FIAORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT O
NUMBER OF FIAORS ���� ���� �� ����G� '�'��� '�`�"`�
•"NEW HOMES ONLY** NUMBER OF BEDROOMS ESTiMATED SELLING PRICE $
► •
Indicate number oJeach type offixhire to be instalied or relocated as par[of this project. Do not include existing fixtures to remain.
MECHANIC.AL
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE WCLUDED WII'H APPLICATION)
AIR HANDLING UNI15 EVAPORATIVE COOLERS GAS PIPE OUTLE'I5 WOODSI'OVFS
BBgS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSEfZIS HOODS�commerc�ap
COMPRESSORS FURNACES F2ANGES
DUCIS GAS LOG SETS REFRIG.SYSI'EMS
PLUMBIIVG
BATHTUBS�orn,e�sn��comcol Lf1VS(BathroomSinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINIQNG FOUP7I'AINS SHOWERS WATER C[ASE.TS RoueU
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
I certify under penalty of perjury that the injormation 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 jurther agree to hold
harmless the City of Federal Way as to any claim(rtcluding costs,ezpenses, and attorneys'fees incurred in the investigation and dejense of
such claim),u�hich may be made by a person,including the undersigned,and fled against the City of Federal Way,but only where such claim
arises out of the reliance of the ci ,including its o.,�"icers and employees,upon the accuracy of the information supplied to the cify as a part of
this appticntion.
NAME/TITLE DATE �'�� ` �
na[ure) [Cide)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other
FOIi,OFFIGE IISE":ONLY
❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR a TENANT IIVIPROVEMENT
BUILDING SHELL ONLY? o YES ❑NO BASIC PLAN? ❑YES ❑NO
ZONIIVG DESIGNATION CHANGE OF USE? a YES ❑NO
NEW ADDRESS REgUIRED? ❑YES o NO UP/SEPA/SU? o YES ❑NO
PLATTED LOT? ❑YES ❑NO DEMO PERMIT REgUIRED? ❑YE.S ❑NO
Bulletin#100—April 2,2007 Page 2 of 4 k�I-Iandouts�Permit Application