08-101567ECEIVE
Fed�'alW-4
iii PERMIT �y
c0's"SI xrrY19M8V8 11MM11 SIP ZOOS j SF MF CO ME EL PL DE E FP
333$58aTBUSSOUMWA,WA 9•6J 9 8 APPLICATION
F&OBRAL, WAY, WA 98UG7.4718
253.835.2607• FAX 253.83 S-2609
emir f �r rrDERAL V''
The following is required Wormation - an incomplete application will not be accepted. Please print legibly (in {nICJ ar type.
/ PROPERTY•. •
SITE ADDRESS 'CS[a�I7T SUITE/UNIT N
ASSESSOR'S TAX/PARCEL # I $ - Q L LOT SIZE (sj)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attaeh aeparate page for lengthy legal deaaipt/or)
N PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING III FIRE PREVENTION SYSTEM
PROJ T DESCRIPTION (Provide detailed description of work included on this permit only)
PROJECT NAME (Name of Business or Owner Last Name) b P' l // LZ- 4D J- P'OSroa -
N PEOPLE INFORMATION
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
NAME
f 4— (—,,-
PRIMARY PHONE -
MAILING ADDRESS
CITY P
E-MAIL ADDRESS
COMPANY NAME �pp��
APPLICANT NAME
OFFI�IC6 PHONZ �7
RILING ADDRESS
�, a� 3�
C . STATE, ZIP
(w; � t��_ �o�--C
CELL PHONE
��s� - 6OA
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
CONTRACTOR'6 RBOISTRATION NUMBER
EXPIRATION DATE
EMAIL ADDRESS
7_46,
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
�✓o'
CITY, STATE, ZIP
CELL PHONE
d -�❑
00'� %�
/fir Lt u�c
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑Tenant 19 Agent Other
(y"1�
HAMS PRIMARY PHONE E-MAIL ADDRESS
So - S �—i I
NAME
Per RCW 19.27.095.
Lender information is required if project value exceeds ✓j5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING ASSESSED/APPRAISED VALUE $—
SPRINKLERED BUILDING? ❑ YES ❑ NO
PROPOSED USE
yALUE OF PROPOSED WORK $ ';� fEt* "gep _
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER,-0 LAKEHAVEN 0 HIGHLINE ❑ PRIVATE SEPTIC)
AREA DESCRIPTION
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS I =UT`aa
"ArEWHOMES ONLY" NUMBER OF BEDROOMS
TOTAL
EXI
c
. FT.
TOTAL
S . FT.
JOPOSEI]
mr— er Tor.,L rRoraaGn er
TarAL ar
SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITHAPPLICATION)
AIR HANDLING UNITS - VAPORATiVE COOLERS
B
FA
GAS PIPE OUTLETS WOODSTOVES
BOILERS
:
FI REP CE INSEjtTS
GAS WATER HEATERS MISC (Describe)
COMPRESSORS
FURNACES �
HOODS Comm,
I "
'
DUCTS
GAS LOG SC''S
RANGES
REFRIG. SYSTEMS
G
BATHTUBS )or Tub/Shower combo)
I VS (BothroomSwce)
DISHWASHERS
RAINWATER SYST
URINALS MISC (Describe)
DRINKING FOUNTAINS
SHOWERS
VACUUM BREAKERS
ELECTRIC WATER HEATERS
SINKS
WATER CLOSETS (rolleq
HOSE BIBBS
SUMPS
WASHING MACHINES
1 cerWy under penalty Of prrjury that I am the property owner or authorised agent of the prop arty awner. I errt(jy that to the brst of my
knowledge, the Wormatian submitted in suppart of this permit application is true and rnrr.et. r c_ u�& Chat I ;,Jiff rory t h with the
bgs tof my
^it9 of �odara., W49 rayulations partatning to the work authortaad by the lssuane
does not remoe of a permit. I understand that the Issuance of this permit
uo the owners raspnnsihtlity for compliance with focal, state, or federal laws regulating construction or environmental law-5.
I furthor agree to hold harmless the City of Federal Way as to any claim (including casts, expenses, and attorneys' fees Incurred In the
ireaestigatton and defense of suci= claim), which may be made by any person, Including the undersigned, and filed against the city+ but only
Peers and employees, upon the accrerac
where such claim arises out of the reliance of the city, including Its ofi►tjormatian supplied to
the city as a part of this appficaCIOn. y of the
SIGNATURE:
o NEW o ADDITION
BUILDING SHELL ONLY?
ZONING DESIGNATION
NEW ADDRESS REQUIRE
PLATTED LOT?
ProgartyOwnerand/orAuthorizedAgent DATE
o ALTERATION a REPAIR q TENANT IMPROVEMENT
a YES o NO BASIC PLAN? a YES ti NO
CHANGE OF USE? o YES o NO
DYES a NO
o YES a NO
iIP/SEPA/SU?
DEMO PERMIT REQiJMD?
o YES a NO
a YES a NO
Bulletin #100 — January 1, 2008 Page 2 of k\HandoutslPermit Application