04-100783 cmr oc�
� ������FE�WAY WA 980G7�18 778
Federa� way RMIT APPLICATION 253�6141I5•FAX:?53-6614729
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, FW File Number: y
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The oilowin is re uired in ormation-an inco Iete a licatiort wil2 not be acce ted. Please rirtt ie ibi (in inl�or �
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SITE ADDRESS: �j��� ������ �, SUITE/APT#
ASSESSOR'S TAX/PARCEL#: � �O� � I - C �' ( G SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTION (e.g.:Acme Estates,Lot 1 J
(Attach separate page for lengthy legal descriptionJ
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TYPE OF PERMIT(This applicatioa�: o BUII.DING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL 0 ENGINEERING�F'IRE PREVENTION SYSTEM
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` PROJECT DESCRIPTION(Provide detailed description of work included on this pernut onluh•
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M{ PROJECT NAME(Name of Business/Owner Last Nam�: '�' �
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PROPERTY NAME: �_ , PRIMARY PHONE:
OWNER � E� S C , � I -
� MAII.ING D RES (STREET ADDRESS;�: CITY,STATE,ZIP
CCONTRACTOR NAME COMPANY OFF[CE PHONE:
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MA[LING ADDRESS(STREET ADDRES ;�: 'CITY,STATE,ZIP CELL PHONE:
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�� TY OF FEDERAL WAY BU NESS LICENSE NUMBER: EXPIRATION DATE: . FAX NUMBER:
1 1-�� l- l G i �i � �- l l (�.53) ��ZZ -����
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� CONTRAC'fORS REGISTRATION NUMBER: EXPIRATtON DATE:
r (copy of cud required with eaeh appllcatioa� � � _ � 1 � P � -/ 'r'� � f� ��7 / � / �
' LENDER NAME: DAYTIME PHONE:
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MAILING ADDRESS(STREET ADDRESS;): C[TY,STATE,ZIP
APPLICANT: NAME• COMPANY OFFICE PHONE:
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MAfLiNG ADDRESS(STREET ADDRESS): C[TY STATE,ZIP EVENING PHONE:
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RELA IONSHIPTO R EC'f: FAX NUMBER:
❑ Architect o Tenant ❑ Other (DescribeJ: ,��'(�j'3) �Zz -(�:I�j�
CONTACT PERSON FOR THIS PROJECT: ❑ Property Owner '§(Contractor �Applicant E-MAIL ADDRESS: . _
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EXISTING USE: PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $ �y� lGCi
SPRINKLERED BUII,DING? �YES O NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: � YFS ❑ NO
WATER SERVICE PROVIDER o LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE O PRIVATE(SEPTIC)
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AREA DESCRIPTION EXISTING SQ. FT__ PROPOSED S(�_FT_ TOTAL
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E3ASEMENI'
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (D�SCRIBI;)
DECK(COVERL;D?)
GARAGE/CARF'ORT
HOW MANY FLOORS? TOTAL EXISTIIJG T07A1 PI20F'OSED TOTAL E`(ISTING AtiD PROPOSED
"NEW HOMES ONLY"* NUMBER OF F3EDROOMS: F,STIMATED SELLING PRICE: $
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Indicate number of each type of fixture that is to Ue installed or relocated as part of this project. Do no[include existing fixtures to remain.
MEl�FIA1VI('.AL
Vafue ofMechanicnl Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS�co�e«,�� WOODSTOVES
BOILERS FIREPLACE INSERT'S RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING I
BATHTUBS�orT�c,/sno..«co�ni,�� StiOWERS WATER CI,OSETS�ro,i�q MISC(Describe)
DISHWASHERS SINKS DRINKWG FOUNTAINS ���
GAS PIPE OUTLETS SUMPS RAINWATF,R SYS
WASHING MACHWES URINALS HOSE E3IE3BS
LAVS�nae,r�m s� VACUUM E3REAKERS ELECTRIC WATER HEATERS
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I certzfy under penalty of pery'ury that the irtformation furnished by me is true and correct to the best of my
krtowledge, and further, that I am authorized by the owner of the above premises to perform the work for which the permit
appiication is made. I further agree to hoid har�nless the City of Federal Way as to any ciaim(incIuding costs, expenses, and
attorneys'fees incurred in the investigation and defense of such claimJ, which may be made by any person, including the
undersigned, artd fiied against the City of Federai Way, but oniy where such ciaim arises out of the reiiance of the city,
inciuding its officers and employees, upon the accuracy of the irtfor�nation suppIied to the city as a part of this application. '
NAME/TITLE: �� 'G 6 v � CG�-/-- ` , �/ � DATE: =�/S/Oi�
ignature� (TiUr�
RELATIONSHIP TO PROJECT: ❑ Property O��mcr g Applicant ��f Contractor ❑ Architect ❑ _
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FOR OFFICE USE ONLY: �
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❑NEW ❑ADDITION ❑ALTERATION o REPAIR c TENANT IMPROVEhiENT i
BUILDING SHELL ONLY? ❑YE.S ❑NO BASIC PLAN? n YES a NO
ZONING DESIGNATION: CHANGE OF USE? ;;YF.S ❑ NO �
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NEW ADDE2FSS REQUIRED? ❑YES u NO UP/SEPA/SU? �:YES ii NO :
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PLATTED LOT? ❑YES ❑ NO DEMO PERMIT FZEQUIRED? ❑YES ❑ NO ,
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