08-103524ctno.4;& RECEIVrC �— 10 5 5_C2'
Federal Way RMIT
COMMUN17Y DEVELOPMENT SERVICES SF MF CO ME EL PL DE EN
3337AVENUE SOU171 • Po BOX 9718 E "APPLICATION
°
FEDERAL WAY, 3-9718
253-835-2607• FAXX T53-853-835-2609
OF FEDERAL WA -- The following is required Worrngtidn. -an incomplete application will not be accepted. Please print legibly (in ink) or type.
SITE ADDRESS C� U S O �1�%%�. �� S (/^h-t� SUITE/UNIT # _
ASSESSOR'S TAX/PARCEL i1 _ _ _ _ - _ _ _ _ LOT SIZE (sf
LEGAL DESCRIPTION (e.g. Acme Estates, Lot I)
Pa..h aq—t. page for k gthg legs! d--1 ,d-q
PROJECT• ' •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING W IRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only]
es'oy +. r G S L�o� !. - •Q• G Z
er c?'a r -r, _ d 4 v
PROJECT NAME (Name of Business or Owner Last Name)
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
NAME PRIMARY; HONE -
MAILING ADDRESS CITY, STATE, ZIP E-MAIL ADDRESS
COMPANY NAME
APPLICANT NAME
OFFICES PF40NE
r
MA !NG ADDRESS
. 6-- dad-
CITY, STATE, ZIP
". d-
CELLPNOHE
- 60
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
WIPI TION DATE
FAX NUMBER
-73 - a a
2 3 t
Ned-) '3�7Y - /Ije.
cONTRAcrowif R;awTPATwx numxR
TXKRAT N DATE
1
E•MA1L ADDRESH
a d r]
ca - of 6
--6�---�
COMPANY NAME
ZZe1NxA--T-r- ,d j--Y
APPLICANT NAME
r—eb
OFFICE PHONE
) -
-MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent w Other
NAME
4) Ga - Co d"Z
NAME
Per RCW 19.27.095.
Lender hVormation is required {jproject value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING ASSESSED/APPRAISED VALUE lA
SPRINKLERED BUILDING? ❑ YES ❑ NO
PROPOSED USE
VALUE OF PROPOSED WORi{��..�rS�1
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
i PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
SO. FT.
BASEMENT
FIRST
—
SECOND
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK (0 COVERED OR ❑ UNCOVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS
°
•aoeos®
r;Tu.
Toms M"Mo er\
Tor" raovaa" sr
Ton,t sr
"NEW HOMES ONLY•*- UMBER 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 .F'__. .
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
PLUMBING
BATHTUBS (or T,b/Shower Combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER H&
HOSE BIBBS
(A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
EVAP r TIVf: COOLERS GAS PIPE OUTLETS _ WOODSTOVES
FANS GAS WATER HEATERS MISC (Describe)
FIREPLACE I ERTS HOODS (Ca.,.i.q
FURNACES RANGES
GAS LOG S • REFRIG. SYSTEMS,
JAVS (Bah- Sbd
URINALS MISC (Describe)
RAINWATER SYST
VACUUM BREAKERS
SHOWERS
WATER CLOSETS rrouey
SINKS
WASHING MACHINES
SUMPS
I cer0fy 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 Wormation sabm(tted 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 permik I understand that the issuance of this permit
does not remove the awner's rasp onsibiltty far compliance with local, state, or fader"! laws regulating construction or environment"( laws.
I further agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred In tfie
inuestigatton and defense of sucl, claim), which may be made hg any person, including the underaigneel, and filed against the clty, Itut aAly
where such claim arises out of tha reliance of the city, including its officers and employees, upon the accuracy of the i,tformation supplied to
the elty as a part of thip�applicaNOn.
SIGNATURE:
find/or Authorized Agent
PATE 'id"
❑ NEW o ADDITION
o ALTERATION
a REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY?
o YES o NO
BASIC PLAN? a YES
a NO
ZONING DESIGNATION
CHANGE OF USE? ❑ YES
❑ NO
NEW ADDRESS REQUIRED?
o YES a NO
UP/SEPA/SU? o YES
o NO
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED? a YES
a NO
Bulletin #100—January 1, 2008
Page 2 of 4
MandoutsTermit Application