07-103455 !►. `" � _
, ctrr oF /
� Federal way ' . -E— � ���5
�����V�� P E R M I T SF MF CO ME EL PL DE EN FP
COMMUNITY DEVELOPMENT SERV/C
� 33:J25 8TM AVENUE SOUTH•PO 90X 9718 � z Q�p p L I C�A T I O N � � � �
FEDERAL WAY,WA 98063•9718 TD
�253-835-�607•FAX 253-835-2609 ��A' � .
unfm�.dluoffede.mluxiu.com IV
The following ts r�e��i{�'o�t�qn-�n incompiete applicattort wili not be accep . Please print legibly(in r type.
�"� L W/•1 T
. � • • - •
SITE ADDRFSS ����d ��/¢�'j l�/�' /�jv�J SUITE/UNIT#
r ASSESSOR'S TAX/PARCEL# __ __ „ _- __ __ LOT SIZE(s�
LEGAL DESCRIPTION(e.g.Acme Estafes,ioc i J
Ftnnd�seyara�e paye/or t�yu�y reqa!aescripnon�
' • • � •
TYPE OF PERMIT .. ❑ BUII.DING O PLUMBING ❑ MECHANICAL
❑ DEMOLITION �$(ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SY3TEM
PROJECT DFSC ON (Frovide detailed desc fion of work included on this permit onlul
` -� /�� C� 7�/
PROJECT NAME(Name of Business or Owner Last Name) L � ���'• r,
` • . • . •
PROPERTY NAME PRtMARY PHONE
OWNER � � C��� � � _
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
�tJ�f/ �i LD (���) �S�- l�
N A DRESS ,,,( C STA ,2 C..LL PHONE
/ 'f� � �/ /�/� `(.J �c, � r_
y � ',� '� CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPI TION DATE FAX NUMBER
V F� _
� �
Co raqa�nd CONTRACTOR'J$REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
w1U sa �ppLntloa � / � � �
�1 d Z L 3 C
APPLICANT COM ,NY NAME APPLICANT NAME OFFICE PHONE
� � '
MAILING ADDRESS C[TY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAXNUMBER
o Architect o Tenant ❑Agent ❑ Other ( � -
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT � ' / ��- � _ �'
LENDER NAME Per RCW 19.27.095:
Lender�nformatiort is required ijproJect value exceeds�5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
� � -
� � � • �
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ V OF PROPOSED WORK � � �C
SPRINKLERED BUILDING? ❑ YE ❑ NO FIRE SUPPRESSION SYSTE OPOSED/REQUIRED? ❑ YES O O
WAT�R SERVICE PROVIDER LAKEHAVEN O HIGHLINE O TACOMA RIVATE(WELL)
SEWER SERVICE PROVIDE AKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
'' AREA DESCRIPTION EXIST"'-= PROPOSED TOTAL
, 5 .P S . FT. S .FT.
' BASEM T • . �
. _ �
' FIRST I
' SECOND i
TH1RD � �
ADDITIONAL FLOORS(DESCRI . .
DECK�(O COVERED OR ❑UNCOVERE �
, GARAGE O CARPORT � � ,
.
NUMBER OF FLOORS �QBT�no rxoroa To�r,u ror,u,�arm�o ar �ror.u,r�orosan ar' ror.v,ar
"'NEW HOMES ONLY"* NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indtcate nuinber of each type of ftxh�re to be ' lled or relocated as part'of th roject: Do not include existing fixtures to semain.
1{�EC�FIAHIC�IL
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE INC ED WI?`H APPLICATIONJ
AIR HANDLINU UNITS EVAPORATNE COOLERS (3AS PIPE OUTL WOODSTOVES
BBQS. FANS c3AS WATER•HEATER MISC(Deacribe)
BOILERS FIREPLACE INSERTS HOODS�c��t.p
COMPRESSORS FURNACE3 �_ RA�d(}ES ' �
DUCTS � ' (3AS IA(3 SETS REFI2ICi.3YSTEM3
PLU]YlBINIi . �
• BATHTUBS�o� /snw�comn�� LAV.S�eoen.00ms�s� URINALS M1S (Describe)
DISHWASHER RAINWATER SYST VACUUM SREAKERS '
DRINHINCi F NTAINS SHOWERS WATER CJ.OSET3 Ron�q
ELE�TRIC WATER HEATERS 31NK3 WASHINO MACHINE3
HOSE BIBBS SUMPS ' �
I
. .
I cert{jy under penalty oj perJury that the fr4/ormation jurnished by me 1s true and correct to ih�bes!oj�ny kieowtedge, and juriher,that I
am authorlaed by the owner oj,the above premtsss to perjorm the work jor which the permit appitcation ia made. !jurther agree to hold
harniless the City of Fedsrat 1Vay as to any eialm(including costs, expense:, and attorneys'jees incurred in the lnvesttgaHon aod dejenst oj
such eIafrM,which may be made by any person,includinq the undersigned, and itled�againsi the C{ty ojFedaral Way.but onIy whers aueh clatm
artses out ojthe reltance of the�tty,including ita ojficers and em yees, upon the accuracy ojthe information supplied to ths city aa a part oj
this applicption.
NAME/TITLE c' % �� ��� � � DATE � Z� �'
1 ign . (7'itle�
RELATIONSHIP TO PROJE ❑ Owner Agent ❑ Contractor ❑ Architect o Other
o NEW o ADDITION o ALTERATION ❑R�EPAIR o TENANT IMPROVEMENT
BUILDINQr SHELL ONLX? o YES o NO. BASIC PLAN? • o YE3 n NO
ZONINQ DESICaNATION CHANGE OF.USE? o YE8 o NO
NEW A�DRE33 REQU3RED? o YES o NO UP/SEPA/SU? o YES o NO
Pi.ATTED LOT? o YE3 o NO IIEMO PERMIT REQUIREDP o YE3 o NO
BuUetin#100—April 2,2007 . Page 2 of 4 k\Handouts\Permit Application