06-103935arr or
- - --_
Federal way RECEIVPERMIT ,,��'�
CO'IM(1M177YI7EvF.7.OP1fENYSERY7C ry SF MF CO ME EL PL DE EN �C'.Y/
sasasdm�nY�nui so(rr�r•Por�ox�j O S APPLICATION
pe
53,835-2 07- fiK � .-2IS
s�•as5-a6or r•�tx ass�sas-asu.�
OF FEDERAL WAY
The b1lowing is req%WU1P0rQF e�in -an ifecpmplete= ppIfca_tion m_Ul not be accepted. Please print legibly (ire ink) or [sire.
SITE ADDRESS 3'4�i aU & 41 .mac-,, 1- .kv(J�m p SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # I 0 1 - -1 0 1 C) LOT SIZE (sfl 22, 2-4;A4p<:r
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) 09 +izLL 1
(Atlnch sep—te pagef r lengthy legal descriplion)
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING y FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this kerrrJft only)
►Nsr►�-�- r( Rc� Paorte �.l =-ysj=m5 ,Ar &&mow u:Ac. AA-r 5-jZvr-c
PROJECT NAME (Name of Business or Owner Last Name) "M �,? 3 % 9�
PEOPLE•• •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
NAME
FC D (:-a e4c. i of y /r1 �ri�rl�Jltt� iNv� S7b�,s� �c-c
PRIMARY PHONE
( ) -
MAILING ADDRESS
3700 �=
CITY, STATE, ZIP
( Wpm , wn 5 r 98 �2l0
COMPANY NAME
MAILING ADDRESS . 41
9 I;L9 A4L--
APPLICANT NAME
OFFICE PHONE
CELL PHONE
0-1( ) �35 - '7G
CITY, STATE, ZIP
-AjA1,Av d rR- 973Q, �1—
CITY OF FEDEILgL WAY BUSINESS LS E NUMBER EXPIRATION DATE
C/
FAX NUMBER
CONTRACTOR'S REGISTRATION NUMBER (copy of card required with each application) EXPIRATION DATE
COMPANY NAME
k P 5
APPLICANT NAME
44W.,.--
OFFICE PHONE
(,Z3 ) 6 `i;-
MA`ILING ADDRESSO �i J ,
.�C�r[YY, SPATE. 73P, /1 y
CELL PHONEA q 4-1
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent )d Other (Describe) l t F � �'
FAX NUMBP:It
(Ib3 ) 492 - SgW
NAME PRIMARY PHONE ADDI7ASS
1.�Ck= �<-Sz,-J (5,
03it rye: L-lw'a.5 .�
Per RCW 19.27.095: Lender information is NAME
required (f project value exceeds $5,000 CA4�mo?-fi e Ib/14i / hk: j
MAILING ADDRESS CnY, STATE, ZiP PHONE
EXISTING ASSESSED/APPRAISED VALUE $_
SPRINKLERED BUILDING? `<YES ❑ NO
WATER SERVICE PROVIDER )<LAKEHAVEN
SEWER SERVICE PROVIDER Y_LAKET--IAVEN
PROPOSED USE
P-f-T?q7 c_
VALUE OF PROPOSED WORK $ 1710
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?xYES ❑ NO
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT ❑
NUMBEP.OFFLOORS
1008TRi0
PROPOSED
TOTAL
ON�
TOTAL ZXMI to BF
TOTAL PROPOBEO BF
TOfIL[ "
&3 Q4
' NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type rJ fixture to be installed or relocated as part of this project. Do not include existing f Ktures to remain.
Value of Mechanical Work $
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS (or Tub/Sho rCombo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAYS (Bathroom Sinks)
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS (commercial)
RANGES
GAS WATER HEATERS
WATER CLOSETS (Toilet)
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I certify under penalty of perjury that the irtformation furnished by me is true and correct to the best of my knowledge, and further, that I
am authorised by the owner of the above premises to perform the work for which the permit application is made. I further agree to hold
harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in the investigation and defense of
such claim), which may be made by any person, including the undersigned, andfiled against the City of Federal Way, but only where such claim
arises out of the reliance of the city, including its officers and employees, upon the accuracy of the Wormation supplied to the city as a part of
this application.
}
y7—
NAME/TITLE
(Signature)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent XContractor
DATE
('nt1e)
❑ Architect .Other 4 d� t A'0<44—
FOR OFFICE USE ONLY
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMCENT
BUILDING SHELL ONLY?
❑ YES ❑ NO
BASIC PLAN?
❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
ONO
NEW ADDRESS REQUIRED?
❑ YES ❑ NO
UP/SEPA/SU?
❑ YES
❑ NO
PLATTED LOT?
❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
Bulletin #100 —January 1, 2006 Page 2 of 4 MHandoutsTermit Application