07-105047CITY DY
Federal Way ��E�V � PERMIT -� -0 !�-1 7
COMMJNITrDEVa0Ph18M'SERV1cE3- " ,;F MF CO ME EL PL DE EN FP
33335 &rr' AMNl1F. , IVA 9 • PO 971 9718 'APPLICATION
�
FEI7ER -2 WAY, IVA S J-8 3.971I i
233•S35.25a7• FAX 833.835•2509
ulurr trl_rnrinury_ l�
1.1=0 fjj\L
The following is req"W; yi9i9 p un incomplete application will not be accepted. Please print legibly (in ink) or type.
PROPERTY INFORMATION
SITE ADDRESS —3 t f tV k 16 - f�1 )►� �� � r V )1 SUITE/UNIT # .[r
ASSESSOR'S TAX/PARCEL # 1 +�- �/ T - 1� LOT: SIZE (so I45 Z
LEGAL DESCRIPTION (e:g. Acme Estates, Lot 1) l d`19l �VC4 y jr4
1Aff ach separafe page Jar lengthy legal dearnprion)
TYPE OF PERMIT ❑ BUILDING O 'PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING 0-FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
PROJECT NAME (Name of Business or Owner Last Name) Fades I �u/,
PROPERTY
OWNER
CONTRACTOR
COPY or cord rcgc
w1tL eoe o,pLlck n
APPLICANT
PROJECT
CONTACT
LENDER
APPLICANT NAME OFFICE PHONE
n 4 &C f t CA r;, tY,`►-ja h (4"s 3) 9 2-d -Y} END
MAIM NO ADDRESS CITY, STATE, ZIP CELL PHONE
TO
O Architect D Tenant []Agent D Other
NAME
E-MAIL
- .21
PerRCW 29.27.095.
Lender information is required Uproject value exceeds $5,0Oo
CrN. STATE, ZIP77PiIDPfE
EXISTING USE t+i ° PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE _ . VALUE OF PROPOSED WORK $_ �� 110
,PRINKLERED BUILDING? Es o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES o NO
WATER SERVICE PROVIDER O LAKEHAVEN D HIGHLINE o TACOMA p PRIVATE (WELL)
SEWER SERVICE PROVIDER o LAKEHAVEN o HIGHLINE 0 TRIVATF. rsFpTrrri
Il r f '?I 'ie
AIM
^ ARrA I)ESC RII N
BASEMENT
FIRST
se I :I a
EXISTING
S , FT.
PROPOSED
SQ. FT.
TOTAL
S . FT.
17 2
:jECOND
THIRD
ADDITIONAL FLOORS (DESCRIBE)
�—
DECK (O COVERED OR O. UNCOVERPD?)
GARAGE O CARPORT n
'
NUMBER OF FLOORS
MUTING
PROPOSED
TOTAL
TOTAL E1rJSTING SP
T.OTAL PROPOSED Sr
TOTAL Sr
"NEW HOMES ONLY"" NUMBER OF BEDROOMS
ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated aspart of this project. Do not include existing fixtures to remain.
Value of Mechanical Work
(A COPY OF BID -OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS
EVAPORATME COOLERS
GAS PIPE OUTLETS WOODSTOVES .
BBQS
FANS
T .GAS WATER HEATERS MISC (Describe)
BOILERS
_ FIREPLACE INSERTS
HOODS )commertiaii
COMPRESSORS
FURNACES
RANGES
DUCTS. I
GAS LOG SETS
REFRIG. SYSTEMS
PLUMBING
BATHTUBS (_Tub/i how rCombo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BI13BS
LAVS (Bathroom Sinks)
URINALS M1SC (Describe)
RAINWATER SYST
VACUUM BREAKERS
SHOWERS
WATER CLOSETS troDeq
SINKS
WASHING MACHINES
SUMPS
I cerft under,penaity 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 cf the above premises to perform the work for which the permit application is made. I further agree to hold
harmless the City of Pederal Way as to any claim (including costs, expenses, and attorneys, fees incurred in the Investigation and defense 4
such claim), which may be made by any person, Including the undersigned, and filed againat the City of Federal Way, but only where such clams
arises out of the reliance of the city, including its officers and employees, upon the accuracy of the Wormatlon suppiied to the city as a part of
this application.
NAME/TITLE C
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent AErContractor ❑ Architect o
o NEW o ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT.
BUILDING SHELL ONLY?
o YES o NO
BASIC PLAN?
o YES
o NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
o NO
NEW ADDRESS REQUIRED?
o YES o NO
UP/SEPA/SU?
o YES
o NO
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED?
o YES
o NO
Bulletin N 1•00 —January 1, 2007 Page 2 of 4 MhandoutMermit Application