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COMMUM7YDEVELOPMENTSERVICES RMIT SF MF CO ME EL PL DE E FP
33325 Bm AVENUE' SOU171 • PO BOX 8718 AUG
"APPLICATION
1
F,E7AP.RALWAY, WA 11M.9718 u G 61 1S
253E �. FAXT53,SA5_2609 P LI CATI O N
=_s rr�e�.:t rr. ERA�L WAY
The following �j,i: I1 U4 - an incomplete application will not be accepted. Please print legibly (in ink) or type.
SITE ADDRESS 2,5_ ElVeNANTEj) PARKWAY S .
ASSESSOR'S TAR/PARCEL # - LOT SIZE (sfl
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) _
■ PROJECT INFORNLATION
TYPE OF PERMIT ❑ BUHMING ❑ PLD![BRiG ❑ MECEUMCAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING XFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed descrlptlon of Mork Included on this Permit onlu)
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PROJECT NAME (Name of Business or Owner Last Name] FWC d E_� _
PEOPLEINFORMATION'
PROPERTY
OWNER
COA,TRACTOR
X
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A *NT
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LENDER
EXISTING USE
NAME a ^ !^ ^i// 1
'I1vq F-� r PW C"!0 S.�t
PRIMARY PHONE
{
MAfL.11YG ADDRESS
CriY. s A m 'Ll P
E-MAtL ADDRESS
C01PPANY NAME
j A,6 l-/G
APPLICANT NAME
RIC*- "AX77Nt:-�77_
OFFICE PHONE
(2-046 ) -7" - 9S"0
Kq [JNGA01)Rh;5.5
CITY. STNVv. ZIP
rrc �.-A 17HAN
CELL P110NF
(Zvb) 9 6
WAY BUS NISS LICKNSF NUMMM
rs7 KRATION DAIF:
PAX NUMBER
I'DER"
�O-0Z -f®Sy97 -Ej0 -- 6V
CD TRACTOWS ON NUM11AR
F.X APATI0M DATF.
E-MAIL ADDRESS
�Ae7Fh�'97 jet
tCl�3l -� `r_
C IPANY NAME
A-c!r/c.
"PI.ICANP WWI;
g/c,'L "4Ar7.vCZ
OFF/CE PHONE:
(2-v6) 7F8 - �v
LING ADORMA S
aP R
MY. SY'ATE. ZIP
r/R 197yy
CELL PHONE
MOW 96 - 4` 67
LAM 0N'SHIP TO P1IO ieEC1'
FAX N11 MBER
Architftt ❑Tenant ❑ Agent Other
E PRIMARY PHONE E-MAUL ADDRESS
m IQIC /+/l e4�T/ /�E� (�o �) 7 S iS - SS o ICKM e_ PFS o !3
NAME Per RCW I8.27.09
L-uf- inftw eaffim is regWred ifprolect value exceeds $5,000
MAILING ADDRESS CPIY. STATE, 22P PHONE
EXISTING ASSESSED/APPRAISED VALUE 4 __
SPRINKLERED BUILDING? ❑ YES ❑ NO
WATER SERVICE PROVIDER
SEWER SERVICE PROVIDER
PROPOSED USE j
VALUE OF PROPOSED WORK
FIRE SUPPRESSION SYSTEM PROPOSEDIRVQU P [-]YES ❑ NO
❑ LAKEHAVEN ❑ HIGHLINE
❑ LAKEHAVEN ❑ HIGHLIDi6
❑ TACOMA ❑ PRIVATE (WEM
❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
EEISTIIIli#
. FT.
PRO90SED
S& FT.
TOTAL
. FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS (DESCRIBES
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
�mc '.oerieen corer
aorecJC[ErsaW
10recr2Vr8®fiF
aorncer
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED 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 aTImA1E MUST BE INCLUDED WCIFI AYPL cA77oN]
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS PIPE OUTLETS WOODSTOVES
BBQS
FANS
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
HOODS tco--iap
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
BATHTUBS (or Tub/sh.—C.mbol LAVS jWiji m Sv, URINALS AIISC (Describe)
DISHWASHERS RAINWATER SYSr VACUUM BRE:AKEnS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS ironed
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
I cent jy under penalty of perjury that I am the property owner or authorized agent of the property owner. I certM that to the hest of my
knowledge, the info,n tine submitted in support of this permit application is true and correct. I certify that I will comply with all applicable
City of Ftcleral Way regulations pertaining to the work authorised bg the issuance Rf a permit. I understand that the issuance of this permit
does not remnve the owner's responsibility fur compliance with local, state, orfederal laws regulating construction or environmental laws,
I further agree to hold harmless the City of Federal Way as to any claim (including mays, expenses, and attorneys' fees incurred in the
int5estigation and defense of such clalm), which may be made by any persan, including the undersigned, and filed against the city, but anW
Where such claim arises our of the reliance Rf , ncluding its offleers and employees, upon the accuracy Rf the ir;format(on supplied to
the city as apart of this applf
SIGNATURE: _ DATE
Authorized
FOR OFFICE USE ONLY
❑ NEW ❑ ADDITION
o ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES ❑ NO
BASIC PLAN? ❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE? o 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, 2008 Page 2 of 4 Mandouts\Permit Application