07-104422 �'` RECEIV F^ � � - .� � �! � .'�
QTY DF
Federai way P E R M I rI'
COMMUNITYDEVELOPMEMfSERV/CES z�07 SF� MF CO ME EL PL DE EN FP
93J25 STN AVENUE SOUTH•P090X 9718 A U G 0 9 � �
FEDERAL WAY,WA 98063-9718 TD ' ���---���
'?53-835-2607.F�z53_835_26a9 � A P�'�L I C�AT I O N /� / �
un a w.c i f wlT e d e r v T v xi u.m m Q I l'Y Q F F�D E F t A L . i
BUILDINQ�EPT.
The foitow{ng is requfred fnformation-an incomplete appitcation wilI not be accepted. Piease print iegibly(tn tnk)or type..
-� • • - •
,�SITE ADDRESS_ �L�J V� I L�� �-�/-�_ � • SUITE/UNIT#
' ASSESSOR'S TAX/PARCEL# �� � ( v�- � {J �� LOT SIZE(s�
LEGAI.DESCRIPTION(e.g.Acme Esfates,Lot 1 J
_ - rAtta�h sepa.au page for tenythy lerpt desaipnon) � �
� ' • • ' •
TYPE OF PERMIT ❑ BUII.DING O PLUMBING ❑ MECHANICAL
O DEMOLITION O ELECTRICAL ❑ ENGINEERING�FF�E PREVENTION SYSTEM
PROJECT DFSGRIPTION (Frovide detailed description of work included on this nermit onlul
7� �!["� �i4F'[ui'I+�1 � :�t�c.����v.,n >�'�KL"� S
� �
I
j
,
PROJECT NAME(Name of Business or Owner Last Name) c1� Cp �
• • • • •
PROPERTY NAME � — . �RIMARY PHONE _
OWNER �
� MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
CON CTOR Jl COMPANY NAME PLICANT NAME OFFICE PHONE
��1 �i`, �.���.C� S�e�.�r� 't 1-cw.5 �c�t.cQ �-e< ��`l ) (o�l� '. �� .
!N(3 DRESS CITY,STATE,ZIP CELL PHONE
�;�.',��`I' u�,`�'� Q,�ax I 3� �el��. �A. �ti� �ld`1 - �020/
��"� , V��t�L� � �T�DE O���yC-�C„'ICOENSE NUMBER EXPIRATI ` D�E ���� �� � �
� 7
► 3 / �1 9
cort o[e.�d r.ymr.a CONTRACTOR'3 REG►STRATlON NUMBER EXPIRATION DATE E-MAIL ADDRESS
wNL}}y�+��ppLe�kba . �/ ��Sq `V � �F 1 p� V�CJ/ � .
�%Li I V\/
APPLICANT COMPANY NAME AP T NAME OFFICE PHONE
� .C. �e. .�c�,- ys� �u.,� h�r�s c so5� 6 - �l�1
MAILt ADDRESS CITY STATE,ZIP CELL PNO
, /8�� / .S�ela� �- :Sa �l -�.1D
RELATIONSHIPTO PROJECT n FAX NUMBER
❑ Architect ❑ Tenant ❑Agent ❑ Other �.(�l n,.,. � res�c�✓ (�d�J) 690 - C���
PROJECT NAME J' ,,,/ PRIMARY PH NE r_ E-MAIL ADDRESS
CONTAC �(�L-1�-6(. � �j��� �Z��
L DER NAME Per RCW 19.27.095:
Lender informaHon is requtred iJproject vaIue exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
� � -
� � : � • • •
EXISTING USE PROP03ED USE
EXiSTING ASSESSED/APPRAISED VALUE$ VALUE OF PROP03ED WORK $ �/ /� �
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? O YES ❑ NO
wAT�R SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA o PRIVATE�WELL�
SEWER SERVICE PROVIDER o LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
' AREA DESCRIPTION EXISTINCi PROPOSED. TOTAL
S .F S •. FT. 3 .FT.
BASEMENT � • � .
FIRST
.SECOND �
THIRD �
ADDITIONAL ORS(DESCRIBE) . •
DECK(O COVERED O ❑UNCOVERED7) '
GARAGE ❑ CARPORT ❑
.
NIIMBER OF FLOORS �° o rxo�oesc ror,n, rnnmaarsrnnaar .ror,wr�orosaosr' ronusr
•"NEW HOMES ONLY'• NUMBER OF BEDRO ESITMATED SELLIN(3 PRICE $
Indicate nuinber of each type of ftxture to be ' Iled or relocated as �of this project: Do not include existing fuctures to semctin.
MECHAHICtlL
Value of Mechanicdl Work$' A COPY OF BID OR ESTIMATE MU 7NCLUDED W17'`H APPLICATION)
AIR HAATDLIN(3 UNIT3 EVAPORATIVE COOLERS (}AS PI . OUTLET3 WOODSTOVES
BBQS. FANS GAS WATE TERS • MISC(Describe) j
BOILERS FIREPI,ACE INSERTS HOOD3(commerd '
COMPRESSORS FURNACE3 T RAJJ(}ES � �
DUCT3 � ' (3A3 LOd SETS REFRI(3.3YSTEM3
PLUMBING .
� BATHTUB3�m /sn�r cams�) LAV.3�BUMoom s�nlca► URINALS MISC(Deec�-ibe)
DI3HWA3H S RAINWATER SY3T VACUUM BREAICERS ' '
DRINKIN OUNTAINS 3HOWERS WATER CjASET3 n'opeq
EL C WATER HEATERS 31NK3 WA3HINR MACHINES
HOSE BIBBS � ' 3UMPS ' •
, .
I eeri(fy under penaity oj perfury that ths f�/ormation fu�nished by me ts true and correct to th�best»jmy knowledge,and further,that I
am authortaed by the owner oj.the above premtses to perform the work jor which ths permit appllcation ts made. !jurther ayree to hold
harniless the City bf Federal Way'as to any ctalm(inciuding costs, expenses, and attorneya'jees ineurred in the fnvestigaHon and dejens�oj
such ciaim,►,which may be made by any person,includinq the undersiqned, and jiled agatnst ths City ojFederal Way,but onIy where auch ciaim
artsea out oj the reltance oj the e�ty,{ncfuding ita ojfieera and employees, upon ihe accuraey oj the i�{jormatton suppliad to ths etty aa a part oj
thi�applicdHon.
NAME/TITLE � DATE V'/"�/
( B r�) rl'itle)
RELATIONS TO PROJECT ❑ O er O Agent �ontractor ❑ Architect O Other
a NEW o ADDITION o ALTERATION o R�EPAIR o TENANT IMPROVEMENT
BUILDING 3HELL ONLX? ' ❑YES o NO . BA3IC PLAN? � o YES n NO
ZONINQr DESIGNATION CHANGE OF.USE? o YES ❑NO
NEW A�DRES3 REQUIREDP o YES o NO UP/SEPA/SU? a YES o NO
PLATTED L01'? o YES o NO IIEMO PERbIIT REQUIRED? a YE3 o NO
Bulletin#100—April 2,2007 . Page 2 of4 kU-�andouts�Permit Application