08-100213 Y
' ���`�����.�
cimoF Q�q �� — �V � �� �
r-����v�� �aN 1 ��RMIT �
COMMUNIT}'DEVEIAPMEM'SERVICES SF MF CO ME EL PL DE EN FP
3332�DERAI,WA SW�8063-90 8971��-�, �F������I O N / /
253-835-2607•FAX 253-835-2609
www.cituoflederalunw.rnm �I'1 c
LJ J
The foliowing is required ir}formation-an incomplete appiication wili not be accepted. Piease print legibty tn ink)or type.
. � . � . �
SITE ADDRESS_ 3��D 2 �y 1`� �YC. .�. �cA�'�ra►� �Q y SUITE/IJNIT#
ASSESSOR'S TA%/PARCEL# �� 2 � � y - 9 D 8 S LOT SIZE(s� B�
LEGAL DESCRIPTTON(e.g.Acme Estates,Lot 1)
�Atmch separate page Jor iengthy ieyal desc.iptioN
' • � ' •
TYPE OF PERNIIT ❑ BUII.DING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING �FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provirle detailed description of work inciuded on this permit onlul
/V�4J C�c dA T O i' I"�c o/� �i/"� G u,.. fr.,/ ��.,.�c I _r r+�e.�� a��f�c Y�e v.-
�
a..v�/ r� /c�.�". Ti�r ..,..�'� �xis t i'«'
PROJECT NAME(Name of Business or Owner Last Namel �YC/'9/"G�'.✓ ��1�q C
.
� � • • •
PROPERTY �ZD� � 9 '.�f�
NAME PRIMARY PHONE
OWNER ,�iJfCl�it'6rr J�r1/fi7c��/ .Lidi,✓
MAII,ING ADDRESS CIT'Y,STA'f'E,ZIP E-MAD,ADDRESS
:�/.�/ E//.e�' �,., �.rao .ScQr�/c G�//9 9�`iz/
CONTRACTOR COMPANY NAME APPLTCAri'T NAiVIE OFFICE PHONE
�''J sio�c�.f 1. ��'iv .dd.�r�- (Zl,�) Z - 37
MAI ADDF2ESS CITY,STATE,ZIP CELL PHONE
P.e, Q�X 73/2 z � P� �i/v �v,q 98.�73 (zr,�) Cy/ -.ri.�3
CITY OF FEDERAL WAY BUSINESS UCENSE NUMBER IF2AT10N DATE FAX NUMBER
/ CONTRACTORU''S REGISTRATION NUMB R— O O '�B� E%PIRATION DATE E�MAII,�AD RFSS/ -��/Y
�� E sQ�/f�s L, 96 3�B�E' /� r-�� iC'c.vb��Zi .�t...r//�. o�
APPLICANT COMCPANY NAME / APPUCAA'T NAME OFFICE PHONE
` ' .� LlGt�G/ l � -
MAILING AD RESS Cl'IY,STATE.ZIP CELL PHONE
l � �
REIAT70NSHIP TO PRQJEC7' FAX NUMBER
❑ Architect ❑ Tenant ❑Agent ❑ Other ( ) -
PROaTECT NP`ME L PRIMARY PHONE �G�C E-MAII,ADDRES���
CONTACT ��'^� '�'�F�/' ( ) - c
LENDER NAME Per RCW 19.27.095:
ti�� Lender information is required if project value exceeds$5.000
MATLING ADDRESS CTIY,STATE,ZIP PHONE
� � -
� � : 1 � 1 1 • ' •
ERISTIING USE Nsi/-.r'i.v., y'.In� PROPOSED USE e�/J f',
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ !�DyZ �
SPRINBLERED BUII.DING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHI.INE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ I.EIKEHAVEN ❑ HIGFII.INE ❑ PRIVATE(SEPTIC)
__ _ __ :._ _.._ _ _ __ _ _ _ _
. _._ __. __ __ _ _ , _ _ _. _
�
.
• . .• -
AREA DESCRIPTION ESISTIIHG PROPOSED TOTAL
. FT. .FT. S .FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FIAORS(DESCRIBE)
DECK(O COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FIAORS ��G ���� �� ���G� ���� ���
D 2 Z
"*NEW HOMES ONLY*" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
► •
Indicate number of each type of fvrture to be installed or relocated as part of this projecL Do not inciude existing furtures to remain
MECI�9INIC`,AL
Va1ue of Mechanical Work$ (A COPY OF BID OR ESTD�IA�MUST BE INCLLIDED WITH APPLICATIOM
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSfOVES
BBQS FANS GAS WAT'ER HEATERS MISC(Describe)
BOILERS FIREPLACE IIVSEFZTS HOODS(comme�aq
COMPRESSORS FURNACES RANGES
DUC'I5 GAS LOG SETS REFRIG.SYSI'EMS
PLUD�ING
BAZT'TI�IIBS(or 7Ub/Shower Combo) LAVS iesuuoom sv�� URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACWM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CIASEI'S�rou�U
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
I cert�fy under penalty oJ perjury that I am the property owner or authorized agent of the property owner.I certiJy that to the best of my
krw�vledge, the information submitted in support of this permit appiication is true and correct.I certify that I wiil comply with all appiicable
City of Federai Way regularions pertaining to the work nuthorized by the issuance of a permit. I understand that the issuance oJ this permit
dces not remoue the owner's responsibility jor compiiance with local,state,or federal laws regulating construction or environmental la�us.
I further agree to hoid hnrmless the GSity of Federal Way as to any claim(inciuding costs, expenses, and attorneys'fees incurred in the
invv�ssti.gatinn and defense of such claim), which may be made by any person, including the undersigned, and,jiled against the city, but oniy
where such claim arises out o,f the reiiance of the city, inciuding its o,�cers and employees, upon the accuracy of the information supptied to
the city as a pnrt of thrs applicarion.
SIGNATURE: � ���%�� DATE f��y���
Property Owner and/or Authorized Agent
�'CiR:flFF'T�'E-�SL*�NY.'f• '
o NEW ❑ADDITION ❑ALTERATION ❑REPAIIt ❑TENANT IIVIPROVEMENT
BUII.DING SHELL ONLY? ❑YES o NO BASIC PLAN? ❑YES c NO
ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REgUIItED? ❑YES ❑NO UP/SEPA/SU? ❑YES ❑NO
PI.ATTED LOT? o YES ❑NO DEMO PERMIT RE$UIItED? ❑YES c NO
Bulletin#100-January_l,2008 _ _ _ _ _ ___ Page 2 of 4 k�IIandouts�Pernrit Application