04-104545 RESU RECEI VE,Q )j2j7
411.CITY OFQWbarfp
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FederalWay REGI0 A - .
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NO V 8 2004 R M I'I�o v 0 8 20U4 SF MF CO ME EL PL DE E FP
COMMUNITY DEVELOPMENT SERVICES
3132E D AVENUE SOUTHWA9•Pp BOX 971N o v o 8 4P P LI��
FEDERAL WAY,WA s343-9718
253.835-2607•FAX 453-BJ$•2609 � F � -o�
�►�DI1VG DEPT.
CITY OF FEDERAL WAY
The olloudng is •u 1 ii_, it,;‘,.,• -an incomplete a.•lication will not be acce•ted. Please ,rint legibly(in ink)or type.
• `,I ■ PROPERTY INFORMATION
SITE ADDRESS 23 `C,VV �CO F -Rde/4 WG{, \p1 SUITE/UNIT tl
2 2 � _
I ASSESSOR'S TAX/PARCEL 0 LOT SIZE(sf _
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
INPROJECT INFORMATION
1 TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
I
I 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING FIRE PREVENTION SYSTEM
PROD T D CRIPTION(Provide detailed description of work included on this permit on1U)
VsfA 1l 6a FV'-e SN ` v 'Ss Vn s\isfokin
PROJECT NAME(Name of Business or Owner Last Name) ')I,(eA(f t) uAttetg/
■ PEOPLE INFORMATION
PROPERTY NAM I Q ,(,�/� PRIMARY PHONE
/ OWNER jrilTj l'f 0p ` ,i 111C�5 I ( ) -
MAILING DDRESS Cr"Y,STATE,ZIP
23i 1 se (�a SA-- I 1Mt/t1f 'rgzc
CONTRACTOR COMPANY NAME Al' LICANT N ME OFFICE PHONE
OfAe U �Ye to\t ' V�i a� Cw A (20(i) -- q 3'z MAIWI,kG�DDRESS CITY, TE , CELL PHONE
53 S LU���� t a 7e q���/� PHI
-
CITY OF FEDE L AY BUSINESS LICENSE NU ER EXPI TION DATE FAX NUMBER
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) /
EXPIRATION DATE
/ /
APPLICANT COMPANY NAME APP�"NT NA E OFFICE PHONE
k,14°` Fa Tak•Okf°h "ll �� (� .a (2 (o) 743 -R3T 2
... t NG RES ,1 1 /► CITY E(},'�ZIP 1 I� (/n�Q �(
�I 3� S Lict1-Q S� 11'Q V"D1 IOIW ,CELL PHONE
i RELATI6NSftIPTO PROJECT l t
FAX NUMBER
O Architect ❑Tenant O Agent Other(Describe) ( ) _
CONTACT I NAMEA, +, 1 PRIMARY PHONE - E-MAIL ADDRESS
~.. I (1 ) 723 9'3a7. I
LENDER Per RC' .27. 95: Le ' °nnation eta NAME
req ,r` sIfpr, ect t $5,000
MAILING Ai 1•ESS
� CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE (ZauraKt. 1
4
PROPOSED USE QVl1rU
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 1 I bb
SPRINKLERED BUILDING? 0 YES )(NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?,
`YES ONO
41r WATER SERVICE PROVIDER AKEHAVEN O IIGHLINE O TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDERN[WAKEHAVEN 0 HIGIH,INE 0 PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING SQ.FT. PRO' D SQ.FT. •
TOTAL 1
BASEMENT .
FIRST
SECOND
THIRD
FOURTH
i
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
i
GARAGE/CARPORT
HOW MANY FLOORS? •TAL►-XInLNG TOTAL PROPOSED TOTAL EXISTING M D PROPOSED
Orr I
"NEW HOMES ONLY"' NUMBER OF BEDROOMS _/ ESTI ED SELLING PRICE $
FIXTURES _ -
Indicate number of each type off e to be installed or relocated as part of this prof-• . Do not include existing fixtures to remain.
t
• MECHANICAL
Value of Mechanical Work $
•
AIR HANDLING UM►; EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(comm<r<caq W OO DSTO V ES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESS••S FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLK Th
PLUMBING
HTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS itod<q MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
ZGAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom , VACUUM BREAKERS ELECTRIC WATER HEATERS
ii
'- DISCLMMER/SIGNATURE BLOCK -
I certify under penalty of perjury that the iform•tion furnished by me is true and correct to the best of my 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. DATE I/YJ b,NAME/TITLE tT�tki
( OIL
ignat reI RELATIONSHIP TO PRO T ❑ Orr ❑ Agent ❑ Contractor ❑ Architect Other 4IQ€
( FOR OFFICE USE ONLY
o NEW o ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? a YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? o YES ❑NO
f.
Bulletin#100—March 30,2004 — Page 2 of 4 k\Handouts—Rcviscd\Permit Application