06-100110( --1134!
RECEIVED
Cl" OF
Cai(FederMUNnY EalVllayLOPMENT VICES JAN 10 2006 PERMIT
33325 B14 AVEMIPSOIl17I. PO WX 97iA
FEt1El7AI. 44A Y. W, I>8 .,17iN �'Y O F (= � � �A-PPLI CATI O N
�;a•a�i5•asu7• FAX 2ss•B�s•sc�,I
BUILDING DEPT.
The followina is required information - an incomplete application will not be
000-((7 o ( (
SF MF CO ME EL PL DE FP
or
SITE ADDRESS ` _, IA
E/UN�IT#
ASSESSOR'S TAX/PARCEL # ('v VIdL E 1'df) LOT SIZ/Zz. 7'r-G
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 2
(Alfnch sepwafe ygpc lengthy legal description/
PROJECT• •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL \ /
El DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING bd FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this hermit onlid / ,
1
N
PROJECT NAME (Name of Business or Owner Last Name) WALWAA4 4-- $ -00
w
PEOPLE• •
PROPERTY
OWNER
CONTRACTOR
scoff Y5
APPLICANT
NAME PRiH1ARY PHONE
MA NG ADDRESS u
CI. STATE, ZIP
GAO l' AA
COMPANY NAME
APPLICANT' N E
OFFICE PHONE
( cl
MAILING DRESS
D
CAL'Ra AVC'5C,
CITY, STA71L ZIP
41-
9-tQ
CELL PHONE
} -
CITY OF FEDERAL WAY 13U "INESS LICENSE NUMBER
EXI-111A ION DATE
FAX NUMBER
B
L
CONTRA R'S
nON NUMSKR (copy of caed reguirad with each application)
EXPIRATION DATTi
COMPANY NAME
APEWCANT NAM
OFFICE PHONE
(2�10) 6 ZL - 1ra►D
L
k &-r5ov►
MAILING ADDRESS
k
CITY. STATE. " P
I 'C � W l' 810`'i
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER /�.
❑ Architect ❑ Tenant ❑ Agent Other (Describe)M
(ALP ) GJ 1iy - 03L1
CONTACT NAME
LENDER Per RCW 18. 7,o9S., Lender information is
required (fproject value exceeds $5,000
MAILING ADDRESS
EXISTING USE
L9Cdo)
NAME
CITY, STATE, ZIP PHONE
PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ A-) A- VALUE OF PROPOSED WORK $ cm
SPRINKLERED BUILDING? YES NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER EIiAVEN ❑ HIGHLINE ❑ TACOMA Li PRIVATE (WELL)
SEWER SERVICE PROVIDER SHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
. Gd M
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
PROPOSED
TOTAL
S . FT.
S . FT.
S.Q. FT.
BASEMENT
FIRST 1 .( fj
` (XjY—�ll/
2
SECOND {
THIRD -
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED?)
GARAGE ❑ CARPORT ❑
EXISTING PROPOBED TOTAL TOTAL ERIBTING Si TMAL ikO)'DEiL W TOTAL BF
NUMBER OF FLOORS ❑� 2� 3:QCl
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE _ $
Indicate number of each type cg
Value of Mechanical Work
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
PLUMBING
BATHTUBS (ornb/shower Combo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS rrwhm n%sinks)
to be installed or relocated as part of this project. Do not include existing Ji_r)rrrc•, to remain.
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS (comet w)
RANGES
GAS WATER HEATERS
WATER CLOSETS (roue[)
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I
am authorized 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, and filed 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 information supplied to the city as apart of
this application.
NAME/TITLE DATE D
y 'k I
RELATIONSHIP TO PRO T ❑Owner ❑Agent ❑Contractor El Architect Other ✓I
FOR OFFICE USE ONLY
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES [:NO
BASIC PLAN? o YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE? ❑ YES
❑ NO
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 k\Handouts\Pe)")nit Application