07-102113 ' nrroc.�/��� ; � " w�`_] — \.:J
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. -� Federa�way REC�IV PERM�T - �
� coMn�uNrrrnBvc�or,xenrsERvlcEs � $F MF CO ME EL PL DE EN�
' 333�53-83SZ�607gF�3�_���� s zo PPLICATION �
FEDSRAL WAY,WA 98063-9718 R � ,{� iD
Ivnuw.df ede.mhua�� �/1 �/ � / .
! rdr� OR.F„�
` The joilowtng is re������tcn incompiete appl{cation wili not be accepted. Please print legibly(in inkJ or. type.
` . _ - • . • • .
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� 3ITE ADDRES3 S� � / / `/ SUITE/UNIT�
� ASSES.SOR'3 TAX/PARCEL R _ _ _ _ _ _- _ _ _ � LOT SIZE(s,�
` LEGAL DESCRIPTION(e:g.Acme Estafes,ior 1)
( �Annch aepa,ctaPagsla k+gt7W kgal deawip8cnl �
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� '1 • • •
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' TYPE OF PERMIT O BUILDINC3 O PLUMBINd ❑ ffiECHAIVICAL
� O DEMOLITION ❑ ELECTRICAL ❑ ENGINk:ERINCi�FIRE PREVENTION SYSTEM
i
f:. PROJECT DESCRIPTION (Provi , tailed description of rk ' oluded on this it onl
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i ; PROJECT NAME(Name of Business or Owner Last Namel r!�-�
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� PROPERTY NAME � - .� PRIMARY PHONE
�I : owxEx � ( � _
• MAILINO A DRESS . CITY,STATE,ZIP E-MAIL ADDRESS
i
CONTRACTOR COMP ME �� � APPL• T NAME OFFICE PHONE
� � (�s31 ��' ao��
MAILINO DDRESS Cl ,STATE, �/ CELL PHONE
C . � IYL�/�Qr ` S3 Co6Cfl -/ Z� 7�-'
, CITY OF FEDERAL WAY BUSiNESS L10EN E NUMBER EXPI ION DATE FAX NUMBER
o�- D - ! 3D �1v- 0-8� r��31 �v�- cas3� �s7-a3iZ.
COPY of cud mqulrcd CON CTORS REGISTRATION NUMBER PIRATI-N DATE E•MAIL ADDRE7�q�
� wltL e■e .ppue.cion � ^-�'/� ��°'Vl./ G • � �• ��1/N� ' Y.
APPLICANT COMP Y NAME APPLICANT NAME OFFICE PHON
��ld� -;��C ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
cl-���'l� _
RELATIONSHIPTO PROJECT �- �"� FAX NUMBER
o Architect o Tenant o Agent ❑ Other T/ � ri�u��lTi•�A�ra( � _
PROJECT NAM PRIMARY PHONE E-MAIL ADDRESS
; CONTACT / /� / rf/f (�7j' - �
LENDER NAME � PerRCW 19�27.095: .
Lende�it�(ormatton ts requtred ij profect value exceeds,�5,000
MAILIN�ADDRESS CITY,STATE,Z1P PHONE '
( � -
� � S � • ' �
EXISTING USE PROPOSED USE •
EXISTING ASSESSED/APPRAISED VALUE $ • _ VALUE OF PROP05ED WORK $ ��}��
SPRINKLERED BUILDING? O YE$ O NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES O NO
WATER SERYICE PROVIDER o LAKEHAVEN o HIGHLINE ❑ TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER O LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
AREA DE5Cr""ION EXISTINC3 PR0�03ED TOTAL
� S .F' � S .FT. S :�'T.
BASEMENT _
FIRST
I
SECOND
9
THIRD . . �
ADDITIONAL FLOORS(DESCRIBE)
DECK(O COVERED OR �UNCOVERED?) '
GARAGE D CARPORT ❑ .
a�uaruio PROPOBSD rarN. ror.u.a�oanNo ar 7�7'AL PRQ►08ED SI ron+c ar
NUMBER OF FLOORS
••NEW HOMES ONLY'• NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ .
�
Indicate number of each type of fixture to be install�d or relocated as part of this project. Do not include ezisting fixtures to remain.
MECHAHICAL
VaIue of Mechanical Work $ (A COpY OF B�D OR ES77MATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UN1TS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
ggQg FpD1g GAS WATER HEATERS MISC(Describe) ,
BOILERS FIREPLACE INSERTS HOODS�comme.da�
COMPRESSORS FURNACES RANGES
D1J ;;. .... .,. (3AS LOG SETS REFRIG.SYSTEMS
,�,�
PLUMBING .
BATHTUBS�orrue/sn�.comno� LAVS�se���s�,xa� URINALS MISC(Describe)
DISHWRSHERS � RAINWATER SYST VACUUM BREAKERS '
DRINIfING FOUNTAINS SHOWERS WATER CLOSETS Ron�q
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BI$BS SUMPS
I cerH under. enalt o er that ihe in ormation uratshed 6 me is true and correct to the best o m knowled e and urther that I
,hJ P y I P .lunJ. I f y .l� y 9 , .r ,
am authortzed by the owner oJ the above premises to perform the work Jor which ihe permit applieallon ia made. I further agree to hoid
harmless the City oj Federal Way as to any clatm (including costs, expenses, and attorneys'jeea incurred in the investtgation and dejenae oj
such c!a!m), which may bs made by any person, includtnq the understgned,and jtted agatnst the City ojFederal Way,but only where such clatm
artses out of the reliance of the ctty,including its oJfZcers and employees, upon the accuracy of the information supplied to the city as a part oj
this application.
NAME/TITLE DATE
(Signature) (Title� '
RELATIONSHIP TO PROJECT o Owner o Agent ❑ Contractor ❑ Architect ❑ Other
: '
❑NEW o ADDITION o AI.TERATION o REPAIR ❑TENANT IMPROVEMENT.
BUILDING SHELL ONL'Y? ❑YE3 ❑NO BA5IC PLAN? o YE3 o NO
ZONING DESIGNATION CHANGE OF USE? ❑YES o NO
NEV{/ADDRESS REQUIRED? o YE3 o NO UP/3EPA/SU? o YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
�
Bulletin#100—January 1,2007 Page 2 of 4 k�Handouts�Permit Application .