05-101334am vF
Federal
f(r-rfa>W•aljuaae�ry
coBSMUA4ryDEVELOPMEPrSoRmRVICF_
plYiEI
V". PERM IT
3332AVENUE li. BOX 9719
FEDERAL WAY, WA98463.9718 Apj,,PLICAT I O N
253-$35.260. FAX 20-635-2609 CL3
SF MF CO ME EL PL DE P, V , P
a
The oIiaurin is re aired in orrreatiare- yeh inco iete a ticati.o►t wilt not be acce ted. Piease print to ibt (in fn or e.
PROPERTY INFORMATION
SITE ADDRESS r Lc CcC H "` 'S SUITE/UNIT IF
ASSESSOR'S TAX/PARCEL # - LOT SIZE (sfJ
LEGAL DESCRIPTION (e.g. Acme Estates, Lot I)
[Anooh lr&MCC page for Ie Wit kVar d--Fpdo )
•■ a ■-� - �
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL -
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING X FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Prot
idde detailed description of work ineiuded on this permit oahi)
Ft�ili►c1 yQc�C An A-63Qfb� i ca 1ud7 U Scri ii�
PROJECT NAME (Name of Business or Owner Last Name) �'-Kge -r I' c'f eI •� LA "n" oy-1
PEOPLEMFORMATION
PROPERTY
OWNER
CONTRACTOR
C�Ifliftv:I�II
LENDER
EXISTING USE
NAME PRIMARY PHONE
f rf�1 �uc5 e� CvYct v-
MAI LINU ADDRESS CITY, STATE, ZIP
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
�f
�Pc
(_36d )5rq 532a1
ae i)n45
)8(,r LI-L lar
MAILING A D DRUS
CrrY, STATE, ZIP ?
CELL PHONE
�: s t�3
a�c0&4— L
(SQ3 l`��1 �62G3
CiTYORAL WAY B INESS EICENSE NUMBER- E3XP TtON DATE
FAX NUMBER
-
I
— — B L
CONTRACTOR'S REGISTRAF)pMHER (copy of c■rd reyalred with each appLitatioaj EXPIRATION DATE
COMPANY NAME
9,
APPLICANT NAME
OFFICE PHONE
(60 s��- 3��
S5,0 5
,e _
MAILING ADDR IIS
CITY, STA , ZIP
CELL PHONE
t l t0a `v, 5f{ 1 QS
[ �t) 3 } V 1 6 2_6
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tcnant ❑ Agent ❑ Other (Describe)
-
PI [ON E
I f-<A^ 1.i7 7-u it; "� -z.- l Ve,,,Af(Zfl r�3 i�CLi J��klfJrse�r��
. Per.4wW 19.27, 095: -Leader irzja rmatioil iS nn�na
required if prvlect t-alue exceeds $510fl0
MAILING ADDRESS I CITY, STATE, ZIP 1
EXISTING ASSESSED/APPRAISED VALUE $,
SPRINELERED BUILDING? ❑ YES ❑ NO
PROPOSED USE y
VALUE OF PROPOSED WORK $
FWE SUPPRESSION SYSTEM PROPOSED/REQUIRED? e7 YES ❑ NO
WATER SERVICE PROVIDER ❑ LA CMAVEN ❑ HIGHLINE ❑ TACOMA In PRIVATE (WELL)
.zL_U=D eIL DvrrrF Ppnvmlwtz n i.AKRTTAVEN ❑ HIGffi.INE ❑ PRIVATE (SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
SO. FT.
PROPOSED
S . FT.
TOTAL,
S . FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
EXISTIlfe
PROYosaO
tOIAL
''OTA4 W=i M'; IGr
TOTAL "Oe m 3f
TO -AL 6r
"NEWtIQMES ONLY"* NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of ftr[ure to be installed or relocated as part of this project. Do not include existing fixtures to remain,
Value ojFMechanica2 Work
_ AIR HANDLING UNITS
— BBQS
BOILERS
_ COMPRESSORS
DUCTS
BATHTUBS (or Tub/Sho—r Combo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS 162uvoam sink
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS {commr��
RANGES
GAS WATER HEATERS
WATER CLOSETS boxy
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC [Describe]
MISC (Describe)
I certify underpenatty of perjury that the information furnished by me is true and correct to the best of my knowledge, and jur-thE , that I
am authorized by the owner of the above premises to perform the work far which the permit opplication 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 elaim)which maCey b .:rcc by any person, including the undersigned andf led against the City of Federal Way, but only where such claim
arises out of the ref ce f ti city, including its offerers and employees, upon the accuracy of the information supplied to the city as u part of
this application
NAME/TITLE
[5 i .NmM re j {TiGej
RELATIONSHIP TOYROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑
54C(pOf
s1
R OFFICE USE ONLY -
Y
o NEW ❑ ADDITION
n ALTERATION
4 u REPAIR n TENANT IMPROVEMENT
BUiLAiNG SHELL ONLY? DYES ❑ NO
BASIC PLAN?
Q YF,S
E) NO
;TiT1�FiHC RESIGNATION
CHANGE. OF USE?
o YES
❑ NO
.NEW ADDRESS REQUIRED? u
YES o NO
UP/SEPA/Sii?
YES
a NO
�Pi.ATTED I.OT?.:.. ❑ YE;S ❑ No
DEMO PERMIT i2I;QLiIREDP
a YES
❑ NO :.'.
BuIlea" #I00 — 7anuary'7, 2005 Page 2 of 4 klHandoutslPerrnit Application