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�e�.e�� Way PERMIT
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253.835-2607• PAX Z53-835-Z609
WWW.d1Wffu'ralu OF FEDER
The following is required i>rifkPP&n —an incomplete application will not be accepted. Please print legibly (in ink) or type.
SITE ADDRESS
ASSESSOR'S TAX/PARCEL # 4-
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page for lengthy legal deavipt(on)
PROJECT• tl
TYPE OF PERMIT
PROJECT DESCRIPTION
SUITE/UNIT i
LOT SIZE (sj) �J �,;r
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING XFIRE PREVENTION SYSTEM
of work included
] 1.) LZ -K,
PROJECT NAME (Name of Business or Owner Last Name)
PROPERTY
NAME
PRIMARY PHONE
OWNER
}
—y
] -
MARANO ADDR S Wf ATE, ZIP
E-MAWAD
I,
^7 e V
CONTRACTOR
PROJECT
CONTACT
LENDER
EXISTING USE
COMPANY NA E
r
PPLICANT NAM&
HONE
PH
/
1�_
`OFFICE
l 7
MAILINO A D
ITY, A E
CELL PHONE
7f "
V kt
�
mac.
ITY OF EDERAL WAY BUSINESS LICENSE UMHER
E TIGN DATE
FAX NUMBER
CONTRACTORIff MOISTMTTON WSMER
Wpuftqox DA�
L-MAIL ADDRESS
5 a
CAMP NY N E
APPLICANT NAME
`OFFICE PHONE
MAILING ADDRESS
CITY. STATE. ZIP
CELL PHOVE
W
.
R LATIONSHIP TO' PROJECT
FA N MBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other
V
NAME PRIMARY PHONE E-MAIL ADDRESS
ASA�� &AdQ&f I (��a 1
NAME
PerRCW 19.27.095.
Lender ir{%rmation is required (fproject value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING ASSESSED/APPRAISED VALUE
SPRINKLERED BUILDING?
❑ YES �_NO
WATER SERVICE PROVIDER
e4 LAKEHAVEN
SEWER SERVICE PROVIDER
"AKEHAVEN
PROPOSED USE
VALUE OF PROPOSED WORK 1 i7
v�
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 13 NO
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION EXISTING PROPOSED TOTAL
BASEMENT
S . FT. S , FT. S . FT.
FIRST
SECOND
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT 0
NUMBER OF FLOORS zeurcikn seoeoeaa tutu. rotor rX071h a ar rorac rxaAasra ar mru. by
*!'NEWHOMES ONLY*" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work $
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
PLUMBING
BATHTUBS (or Tub/Shower combo(
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
(A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
EVAPORATIVE COOLERS
FANS
F(REP LAC I, 1NSERTS
FURNACES
GAS LOG SETS
LAVS (Bathroom Sines)
RAINWATER SYST
SHOWERS
SINKS
ar nrcc
GAS PIPE OUTLETS
GAS WATER HEATERS
HOODS (commerdaq
RANGES '
REFRIG. SYSTEMS
URINALS
VACUUM BREAKERS
WATER CLOSETS (rouaq
WASHING MACHINES
WOODSTOVES
MISC (Describe)
I certify under penalty of perfury that I am tite property owner or authorized agent of the property owner. I certify that to the best of my
knowledge, the ifiJormation submitted in support of this permit application is true and correct. I cert(fy that I wilt comply with all applicable
City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the issuance of this permit
does not remove the owner's responsibility for compliance with IocaI, state, or federal laws regulating construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys, fees incurred in tite
investigation and defense of such claim), tuhich may be made by any person, including the undersigned, and filed against the city, but only
where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the ir�formatten supplied to
the city as a part of this application.
SIGNATURE:
Owner
o NEW ❑ ADDITION
o ALTERATION
BUILDING SHELL ONLY?
o YES o NO
ZONING DESIGNATION
NEW ADDRESS REQUIRED?
o YES a NO
PLATTED LOT?
o YES ❑ NO
DATE -:
or Autbd&59d Aeent
a REPAIR o. TENANT IMPROVEMENT
1. HASIC PLAN? o YES ii NO
CHANGE OF USE?
UP/SEPA/SU?
DEMO PERMIT REQUIRED?
o YES o NO
❑ YES a NO
o YES o NO
Bulletin #100 — January 1, 2008 Page 2 of 4 k\Handouts\Pern it Application