08-102123 c�my,�w���.x',� ������ - �� � � �
f��� Y`Y�A� �� � — — — —
��' PERMIT
f70NAlUMTYDBVSLOPMBM'SBRVICBS MpY 0 1 2008 SF MF CO ME EL PL DE EN�
933T58�AVENUB SOUTX•PO BOX 9718 D�����C AT I O N �
P6DBRAL WAY,WA 98069•9718
' 759-d,9ST607•PAX Y53-d35•?609 O� ��
The foilowing is requtred i�{fo�l e l�bn-an incomplete appiication wiii not be accepted. Piease print legWiy(in{nlcf or ty .
.� . � . �
SITE ADDRES8 ' � C` S • � � 3IIITE/UNIT#�
AS48E530R'3 TAX/PARCEL� � �! � `, t`- / � � _� LOT BIZE(s�
LEQrAL DFSCRIPTION(e.g.Acme Estates,Lof 1 J
�er�n,ywrou a�lw��w J���l
� • • •
I TYPE OF PERMIT O BUII.DINCi D PLIIMBINQ ❑ MECHANICAL
0 DEMOLITION � ELECTRICAL � EN(�INEERIN(3 Q FIRE PREVENTION SYSTEM
�
PROJECT DE3CRIPTION(Provide detailed description of work irtcluded on this permit onlu►
'iY� �.�1 \r v. 1 A t ��„��'4 Y�v CL��Y�� i t1 �Y f�iY[ � ����9(0"
PROJECT NAME(Name of Business or Owner Last Name) � ����.���( � (��7,�, �
_—�_.
• ' • • �
PROPERTY �ME PRIMARY PHON&
owxER 1 2 � c��� ' w � ( 1 -
MAILINd ADDRE - CITY,STATE,ZIP E-MAIL ADDRFS3
I
CONTRACTOR �MPANY NAM& APPLICANT NAME OFF[CE PHONB
rar (2a6 ) 22 - �Z
G MAi N ADDR 3 CITY,STATE,ZIP CELL PHONE
�� � d �' r^ �� 1� 2c�6 � - 2 �
C OF E ERAL WAY BUS ES3 UCENSE NUMBER EXPIRAT N DAT FAX NUMHER
C ��_ �ozr3D �z � a�' c . � -
CONTRACTOR'8 R8QI8TRATION NUMBER TI 8 DAT& E-MA1L ADDRE3S
---, �
�
' APPLICANT COMPANY NAME APPIIGNT NAME ORFICE PHONE
--- -- �,. � � -
L NO ADDRE33 CITY,STATE,ZIP CELL PHONE
G� •� -� �O � .�- Z � - �
� REfA ON HI TO PROJECT R NUMBER -
❑ Architect ❑Tenant ❑Agent ❑ Other ( �
PROJECT NAME � PRIMARY PHONE &-MAIL ADDRESS
CONTACT �' �� _ .��" �
LENDER NAME Per RCW 19.?7.096:
L�nds�iqformallon is required�/'proJsct vaius excttds 7j6,000
MAIWNO ADDRESS CITY,STATE,Z[P PHONE
. � i ' ( � -
� � : � • •
EXI3TINQ USE PROPOSED U$E
EXISTINQ A83ES3ED/APPRAI3ED VALUE� VALUE OF PROPOSED WORK $ j��,�+° �6
8PRTM{LERED BUbDII�iCi? ❑YE3 o NO FIRE SUPPRE33ION 3YSTEM PROP09ED/REQUIRED? ❑YE3 a NO
WATER SERVIC�PROVIDER ❑ LAKEHAVEN � HIGHLINE ❑ TACOMA ❑ PRNATE(WELL)
3EWER SERVICE PROVIDER ❑ LAKEIiAVEN ❑ HI4FII.INE O PRNATE(SEPTIC) '
-• s�-
AREA DESCRIPTION EXISTINQr PROPOSED TOTAL
3 .FT. 3 .FT. 3 .FT.
BASEMENT
FIRSf
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(O COVERED OR ❑UNCOVERED?) j
GARAGE ❑ CARPORT O
NUMBER OF FIAORS �� r�oro'm T°ru' ror"i�°°r T°na m°r°°a°'r mn�c sr
' i
•"NEWHOMES ONLY'" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate num6er of each type of fixture to be installed r re[ocated as pnrt of this project. Do not include existtng fudures to remain. �
MECHAIVICAL
Vatue of Mechanical Work$ (A COPI'OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATIONJ
AIR HANDLIN(3 UNITS EV RATIVE COOLERS QA3 PIPE OUTLETS WOODSTOVES
BBQS F (iAe WATER HEATER3 MI3C(Deacribe)
BOILERS PLACE INSERT3 HOOD3�cnmmerd.q �
COMPRESSOR3 RNACE3 RANdE3
DUCT3 A3 LOO SETS REFRIC}.3Y3TEM3 I
PLUMBIN(i
BATHTUB3�a nn/sh�c comco� LAVS�s.et,�aom sw� URINAL3 MI3C(Deacribe) I
DISHWA3HER3 RAINWATER 3Y3T VACWM BREAKERS
DRINHING FOUNTAIN3 3HOWERS WATER CL03ETS(rot�eq
ELECTRIC WATER HEATERS 3INKS WA3HIN(}MACHINES
H03E BIBB3 3UMP3
. . ' �
!cett{jy under penaity oj perJury that I am the property owner or authorlaed agent oj tlu property ownsn I car!{fy that to the bsat of my +
knowiedgt, the it{jormation submttted in tepport oj thts psrmtt applicatton ia true and correc�t.I cert�f'y that I will eomply wtth all applicable
City of Fsderal Way rtgulaHons perta{ntng to tht work authoiiaed by the iasuanee oj a permiG 1 understand that the tsauanee of this per►nit �
does no!rsmovs the owner'a responsibility jor compHance wlth tocai,state,or fsderal lawa regulaHrtg conatruction or envlronmentai laws.
I further agree to hoid harmfesa the C{iy oJ!'ederai Way as to any claim(fncluding costs, expsnsea, and atlorneys'jees incurnd in the
invsatigation and d�/sna�oj aueh claimJ, which may 6e made by any peraon, iriciuding tha underaigned, and Jiie agatnat tiu city, but only
whsn such c[aim arlses oai of the niiance ojlht ctty, ineluding ita officen and employeea,upon the accuracy of he t►4jornt on auppited to
the city as a par!ojthis appiicaN . �
; � l �BIC�NATURE: �� � � DATE
Proper4Y Owner and/or Authoriud Agent
o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUII.DINQ 8Fffi.T.ONLY? a YE$ o NO BASIC PLANP a YE8 o NO
ZONII�iQ DESIQ�NATION CHAN(3E OF U3EP o YES o NO
NEW ADDRFS3 REQUIRED� a YE9 o NO UP/SEPA/$U? o YES a NO
PLATTED LOT? o YE3 o NO DEMO PERMIT REQUIRED? o YES a NO
Bulletin#100—January 1,2008 Page 2 of 4 k�I-Iandouts�Pernvt Application