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Federal Way PERMIT
COMMUMNDEVELOPMENPSERVJCES
3332"" Y.WAaSO�3970997MAR 2 4 ?APPLICATION
253-635-2607• FAX 253-95-2609
11311—dW '
1.,ffy OF FEDERAL WA'.
The f011awing is reauik-4 lBMOtiofx-F- an incomplete application will not be
SITE ADDRESS 28&* Z S
LI -IJQ.Lf.y2—
SF MF CO ME EL PL DE �1V
63
tecL PIease print Legibly tin ink) or tope.
SUITE/UNIT #
ASSESSOR'S TAR/PARCEL # .1 L q C - D -z' Lb 0 LOT SIZE (sf
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) 64q, C-& ] ?,:.,,..,r e-,
umrch -lq- epWf-L-Wft desalpCori)
PROJE
CT INFORMATION
a
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL //
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING &-FIRE PREVENTION SYSTEM
PROJECT DESCRE H (ProDide de scr on this hermit oniu)
bVU V n
PROJECT NAME (Name of Business or Owner Last Name) r Ifry
PEOPLEO• •
PROPERTY NAnrE PRIMARY PHONE
OWNER)g�js"
G; G�
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
�v • Sak z-2,("y
MAMING ADDRESS CRY. StA7E, ZIP CELL PHONE
!fib 1 rr 8-ram- , ttcW *,>cq (�" -
L _
❑ Architect ❑ Tenant ❑ Agent Cher (Descd[be) � -
FAX NUMI3CR
7� PRIMARY PHONE
c
FMAILADDRESS
( y�
FerRCW 19..27,095: Lender Wbrmatlon is NAME
Tequired tfprglaat value exceeds $is,000
VIAUJKU ADDRESS Cl2Y, smit. ZIP
PHONE
J.
EXISTING ASSESSED/APPRAISEDVALUE•
SPRINKLERED BUILDING? Pe / YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN
SEWER SERVICE PROVIDER ❑ LAEEHAVEN
PROPOSED USE
VALUE OF PROPOSED WORK
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ MGHLINE 0 PRIVATE (SEPTIC]
AREA DESCRIPTION
EXISTING
. FT.
PROPOSED
FT.
TOTAL
89. FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS r C7 )POrn - 1i TOTALMKMMO9r TOTAL BF MALar
�0LC17c
"IVEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of f xc re to be installed or relocated as part of this project Do not include existing fixtures to remain.
Value of Mechanical Work S
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS ("Tub/Sho C®bo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
EAVS ra.L :—mS-nlwil
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS (co en2w)
RANGES
GAS WATER HEATERS
WATER CLOSETS aw+ 4
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I certify under penalty of perjury that the Wormation 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, agxmses, and attorneys' fees incurred In the irwestigation and defense of
such claim). which may be ma��X.
person, including the undersigned, and filed against the City of Federal Way, but only inhere such claim
arises out of the reliance of thLuding its o ficers and employees, upon the accuracy of the igformation supplied to the city as apart of
this appticat{an.
NAAW/TITLE
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent 6 Carltractor ❑ Architect ❑
-3 I 2�,.3 / PATH
FOR OFFICE USE ONLY
o NEW o ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT 12"R:OVEMENT
BUILDING SHELL ONLY?
❑ YES ❑ NO
BASIC PLAN?
❑ 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\Permit Application