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Feaera�way REG P E R M I T � '�" —
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333ZFEDERAL WAYSW�E0���189�18 APR o 9��,TL I C AT I O N
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753-835-2607•FAX 253-8J5•2609 1 / /
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The foiIowtng ts requ�ed�t�[oDn�an incomplete appIication wiil net be accepted. Please print ieg{bly(in ink)or type.
. � . � . �
SITE ADDRESS '•� � SUITE/UNIT#
ASSE9SOR'3 TAX/PARCEL# _ _ _ _ _ _ - _ _ _ � LOT SIZE(s�
LEGAL DESCRIPTION(e.g.Acme Estates;Lot 1 J
. /Attarh separate poge for fengthy Iega7 descriptionf .
. � •.' .
TYPE OF PERMIT O BUILDING � PLUMBING O MECIiANICAL
• ❑ DEMOLITION ❑ ELECTRICAL O ENGINEERING�FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Pro�ide detailed description of work in.cluded this permit onlu)
���'Y�E� �1���'�'S�'i`/�l9 �''�J` � � �
,
PROJECT NAME(Name of Business or Owner Last Name) (�� �� ,
• • � • •
PROPERTY xAME � �
PRIMA Y�Hpy�
OWNER � � „�
MAIL[NO AD E C1TY,STATE,ZIP E-MAIL ADDRESS
�� '�S�-
CONTRACTOR C ANY NAME ! APP6ICANT NAME OFFICE HONE
1� y 1 ° 1�U I,.�J' �/-�
ILI a ADDRESS C ,$T TEi 1P f�', CE�;PF{pNE
� � - � '` v .��Q - �
CiTY OF EDERAL WAY BUSiNESS�ICENSE NUMB R EXPIRATI N ATE FAX NUt�J R
,�0�-D.� — d3 .� �--c�� � � (• � );.� 3 d�c�
copv ote.ra.aqnlna CONTRACTORS RECISTRA ION NUMBER EXPIRATlON DATE E-MAIL ADDR SS
wdt6 e�eh�pplle�tlon �y -` . . '— � .
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APPLICANT COMP NY NAME APPLICANT NAME
1 �11� � OFFICEPHONE _.
� MAILING ADDRESS � � . CITY,STATE,ZIP � � �ELL PHONE
REL,ATIONSHIPTO PROJECT FAX NUMBER '
o Architect ❑ Tenant ❑Agent ❑ Other � � _
PROJECT NAME�^ PRIMA Y PHONE
CONTACT " �a�{_� � E-MAIL ADDRESS
\.J�,J - �
LENDER NAME � Per RCW 19.27.095: .
Lender tnforntation ts requ{red if proJect value eacceeds,�5,000
MAfUNG ADDRESS CITY,STATE,ZIP PHONE •
l � _
� � : � • • •
EXISTING USE PRUPOSED USE �
` EXISTING ASSESSED/APPRAISED VALUE $ � _ VALUE OF PROP05ED WORK $ ��� �
(
SPRINKLERED BUILDING? O YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER O LAKEHAVEN ❑ HIGHI,INE O TACOMA O PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN O HIGHLINE ❑ PRIVATE(SEPTIC)
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AREA DESCRI EXISTING PRO�OSED TOTAL
� S :FT: S .FT. S .FT.
BASEMENT
FIRST �
SECOND �
�
THIRD .
ADDITIONAL FLOORS(DESCRIBE)
DECK(O COVERED OR ❑UNCOVERED?)
GARAGE � CARPORT ❑
cxtsrrna PROPOSSD rarnt ror.u.a�asr+No ar TATAL PROP03LD 87 rornc sr
NUMBER OF FLOORS
,
""NEW HOMES ONLY'" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each fype of fixture to be installed or refocated as part of this projecf: Do not inc(ude existing fzrtures to remain.
MECHAHICAL I
Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATIONJ 1
A1R HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC�Describe)
BOILERS FIREPLACE INSERTS HOODS�cnmme.d.q
COMPRESSORS FURNACES RANC3ES '
DUC'�'S;
(3AS LOG SETS REFRIG.SYSTEMS .
PLUIYIBING ,
BATHTUBS�orT�b/sn��comnol LAVS�saw�ms�,ks) URINALS MISC(Describe)
DISH�NASHERS � RAINWATER SYST VACUUM BREAKERS '
DRINKING FOUNTAINS SHOWERS WATER CLOSETS Roneq
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BI$BS SUMPS
I ce under. enait o er u that the in ormat{on urnished b me ts true and correct to the best o,/my knowledge, and jurther, lhat I
�h✓ P yIP I �. I I �
am authortzed by the owner of the above premises to perJorm the work for urhich the permlt appiicatton is made. I jurther agree to hold
harneless the Ctty of Federai Way as to any ciatm(includinq costs, expenses, and attorneys'jees tncurred in the lnvestigallon and defense oj
such clatm/, whtch may 6e made by ang person,including the unders{gned,and fi�ed aqatnst the City ojFedsral Way,but only where such clatm
arlses out oj the reliance oj the city,{ncluding its off{cers and employtes, apon the accuracy of the t�j'ormatlon suppl ed to the city as a part of
this application.
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. i ���
NAME/TITLE - DATE ''—
re) �Titlq
RELATIONSHIP TOIP C Owner o Agent o Con ac r � Architect ❑ Other
�
❑NEW o ADDITION o ALTERATION o REPAIR ❑TENANT IMPROVEMENT.
BUII.DING SHELL ONLY? o YES o NO BASIC PLAN? o YES ❑NO
ZONINC3 DESIGNATION CFIANGE OF USE? o YES ❑NO
NEW ADDRES3 REQUIRED? o YES o NO UP/SEPA/3U? o YES a NO
PLATTED LOT? o YE3 o NO DEMO PERMIT REQUIRED? o YE3 ❑NO
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Bulletin#100—January 1,2007 Page 2 of4 kU-Iandouts�Permit Application . J