06-106443 _A*°4=*-Y OF r1w../ R EC EI\ D -
Federal Way 1t� A D___(--____ .
PERMIT
COMMUNTYDEVELOPMENT SERVICES DEC 2 6APPLI
SF MF CO ME EL PL DE EN
33325 7 AnNuw E SOUTTi•p0 BOX 971�-• C A T I O N
FEDERAL WAY,WA 98063-97]8 rp
253-835.2607•FAX 253-035-2��TY OF FEDERAL WAY
mww.cayol!'(2.'rclwa4 tv,n __�_
BUILDING DEPT.
The oilowin• is re.uired in ormation-an Inco •lete a..lication will not be acce•ted. Please .rint le.ibl in in or
i
SITE ADDRESS 3/ p 2g1/7/ AKE S `,Cy�44C Lf./14Y SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# U 9 Z l 0 -1 - 9 / / LOT SIZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach upnrate page f lengthy legal description)
• ■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING ( 'FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
1-4 s-ia/a4/o r' r.9(' 4e', /re h.?e (I" Di ) /4avdhl., a
27ntt6le 'Velee-id r Cheer 4i Wive- eonnec•/,0 n.
PROJECT NAME(Name of Business or Owner Last Name) Ui 6, est,„, - .4_ -
PEOPLE.INFORMATION
PROPERTY NAME / / PRIMARY PHONE
OWNER V/ZZ4 ,E.S,�/e�I/2/z4 zL e l (20 4 ) -c/6 i - Y 1�
gXD 1
MMI.INC;AnORFSS 1 CIT1, ITE,EL'
3 08 S 4A74ri/,vE Jr ! .._Cea•1/4' 114 Q. //f
CONTRACTOR COMPANY NAME
APPLICANT NAME OFFICE PHO';F.
4/1/4nle(I I;ice fko/e. e4/00 A/a-/h64 Pr Iran ( y25) r3 - .x'637
MAILING ADDRESS CITY,/ASTATE,ZIP
/973s 1-VY71-/Ty ,�1 vC �EC Woodi,,vi/le t4/14 CELL PHONE _
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
If- e- / - D o 0 o b 7- B L /2 / 3/ lei ( )
CONTRACTORS REGISTRATION NUMBER(copy of card regnlred with each application) EXPIRATION DATE
/} !J ✓ 4 iv C P / 1 9 /3 6. l l
APPLICANT COMPANY NAME APPLICANT NAME ., OFFICE PHONE
me rne ( ) -
MAILINC,AnnRFSS CITY,STATE,ZIP — CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMB ER
0 Architect ❑ Tenant o Agent ❑ Other(Describe) ( )
CONTACT NAME !"�
PRIMARY PHONE MAIL ADDRESS
jet iLl4/7 it./lG/7 (•C/ZS )WI'3 -S 6S7 I)*onG lhc�il.mil/G,i
LENDER p • NAME
'"" ro e lueercee 000 5 '
MAILING pADDRESS CITY,STATE,ZIP
IN DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXTST[Nf;ASSESSED/APPRJ JSED VALUE a ? 2 )O
'+' VALUE v Y'L<VL'U:JL'U W V[Lt1 � J
SPRINKLERED BUILDING? I/YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PRnITTDER DIT Arrr-.FTA-Tr:•rr _ -., TIT r,, ,r-r.-, . ., . ..
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
12/22/2006 )18:26 4254835'7 ADVANCED FIRE PAGE 02/02
M L •.
■ PRoJI CT FLOOR AREAS
AREA DESCRIPTION. EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL
BASEMENT
•
FIRST -
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EX1S71NG TOTAL YKrJSItV TOTAL E`fISRNG AND PROPIV.r
"NEW HOMES ONLY" NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE 5
■ FIXTURES
Indicate number of each type of fixture that Is to be Installed or relocated as part of this project. De not include exist[ng fLxtures to rerr,3in.
IrF,CHANICAL
Vsr)ue or Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIC.SYSTEMS
BBQS FTS HOODS IC,,,o,mer WCODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe}
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS — CAS PIPE OUTLETS
PLUMBING
BATHTUBS(orT„nist,ower Combo) SHOWERS WATER CLOSETS rt.o..,l MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS _ SUMPS RAINWATER SYS
WASHING MACHINES URINALS HOSE BIBBS
LAVS ip,,rl„Yv,,,,s,ok VACUUM BREAKERS ELECTRIC WATER HEATERS
I certify under penalty of perjury that the information furnished by me is true and correct to the best oFmy knowledge.
and Further, that I am authorized by the owner of the above premises to perform the work for which the permit application is .
made. I further agree to hold harmless the City of Federal Way as to any claim (Including costs, expenses, and attorneys'Fees
incurred in the investigation and defense of such claim), which may be made by any person, including the undersigned, and
filed against the City of Federal Way, but only where such claim arises out of the reliance of the city, including its officers
and employees, upon the accuracy of the information supplied to the city as a part of this application. -
NAME/TITLE: QTO/2a"/AU/1 Para")/rarh JP /7r DATE: 12_-__?_6 -
(Slgneture) (Tutrl
RELATIONSHIP TO PROJECT: ? Property Owner C AppticE ? Contractor ? Architect ?
FOR OFFICE USE ONLY:
7 NEW 7 ADDITION 7 ALTERATION ?REPAIR 7 TENANT IMPROVEMENT
BUILDING SHELL ONLY? ?YES ?NO BASIC PLAN? ?YES ?NO
ZONING DESIGNATION: CHANGE OF USE? ?YES 7 NO
JNEW ADDRESS REQUIRED? ?YES 7 NO UP/SEPA/SU? ?YES 7 NO
PLATTED LOT? ?YES 7 NO . . DEMO PERMIT REQUIRED? 7 YES ?NO
Bulletin#100-January 13,2004 Page 2 of 4 k:\Handouts-Revised\Pennit Application