08-103452'ARECEIVF)
Federal Way JULYS 2008 PERMIT
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253-835-2607• FAX 253-835-2609
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The following is required information - an incomplete application will not be accepted. Please print legibly (in ink) or type.
PROPERTY•. •
SITE ADDRESS �14 SUITE/UNIT # _
ASSESSOR'S TAX/PARCEL #
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) VW 1 4
(Attach separate pagel r lengthy legal desertptioN
PROJECT• •
LOT SIZE (sO
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING\,,G FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only
PNec- VST 4 -
PROJECT NAME (Name of Business or Owner Last Hamel _ W1
PROPERTY
OWNER
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
PEOPLE INFORMATION
NAME
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OFFICE PHONE
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PRIMARY PHONE
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MAILING ADDIIF 5
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STATE, ZIPCELL
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CITY. STATE. ZIP "I faCY)3
E-MAILADDRESS
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COMPANY NAME S� l�w�ei
APPLICANT NAMF.
OFFICE PHONE
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MAR-I.NG ADDRESS
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STATE, ZIPCELL
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PHONE
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RELATIONSHIP TO PROJECT
FAX NUMBER
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CITY, OF FEDERAL WA�N P S L�PENSE 1VLiM6ER
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FAX NUMBER
lE-MAIL
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ADDRESS
OMPANY NAME
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PLICANT NAME
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OFFICE PHONE
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CiiY. STAIE. GIP
CELL PHONE
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RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other
("Z&) 7,q l
N E P MAR]' NE 8•MAILADDRESS
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NAME Per RCW 19.27.095:
Lender information is required (f project value exceeds $5,000
MAILING ADDRESS CITY. STATE, ZIP PHONE
( )
EXISTING ASSESSED/APPRAISED VALUE S
SPRINKLERED BUILDING? ❑ YES ❑ NO
_ PROPOSED USE
VALUE OF PROPOSED WORK $ I I b
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC}
N PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
S . FT.
BASEMENT
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
FIRST
COMPRESSORS
FURNACES
RANGES
SECOND
GAS LOG SETS
REFRIG. SYSTEMS
D YES D NO
THIRD
D YES
D NO
PLATTED LOT?
ADDITIONAL FLOORS (DESCRIBE)
DEMO PERMIT REQUIRED?
D YES
D NO
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
R-15TING
PROPOS®
TOTAL
TOTAL EXrSrBVG BF
TOTAL PROPOSED SF
TOTAL SP
"NEW HOMES ONLY"" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work
(A COPY OF BID OR ESTHUATE MUST BE 17VCLLTDED WITH APPLICATIOM
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS PIPE OUTLETS WOODSTOVES
BBQS
FANS
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
HOODS (Commercial)
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
BATHTUBS (or Rib/Shower Combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
LAVS (Bathroom Sinks) URINALS MISC (Describe)
RAINWATER SYST VACUUM BREAKERS
SHOWERS WATER CLOSETS tibu."
SINKS WASHING MACHINES
SUMPS
I certify under penalty of perjury that I am the property owner or, authorized agent of the property owner. I certify that to the best of my
knowledge, the fgormation submitted in support of this permit application is true and correct. I cert>jjy that I will comply with all applicable
City of Federal Way regulations pertaining to the work authorized by the Issuance of a permit. I understand that tate issuance of this permit
does not remove the owner's responsibilityfar compliance with local, state, orfederal laws regulating construction or environmental taws.
I further agree to hold harmless the City 4f Federal Way as to any claire (including costs, expenses, and attorneys' fees incurred in the
Investigation and defense of such claw, which may be made by any person. Including the undersigned, and filed against the city, but only
inhere such claim arises out of t e-relthe city, including its officers and employees, upon the accuracy of the information supplied to
the city as a pgri of flits applic4lon. fa`nc-�
SIGNATURE:
Owner and/or Authorized
FOR OFFICE USE ONLY
❑ NEW D ADDITION
❑ ALTERATION
❑ REPAIR D TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES ❑ NO
BASIC PLAN?
❑ YES
D NO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
❑ NO
NEW ADDRESS REQUIRED?
D YES D NO
UP/SEPA/SU?
D YES
D NO
PLATTED LOT?
D YES o NO
DEMO PERMIT REQUIRED?
D YES
D NO
Bulletin #100 – August 16, 2007 Page 2 of 4 k\Handouts\Permit Application