07-106667A
RECEk,®
MY OF
Federal Way DEC 112007 PERMIT
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE EN
3332WZMA WADY WA'L98W- PO9VITOF FEaE LIGATION
zss•a3sssn7•F�vtssaass•zsos BUILDING
�+tutu.slL1l+rlkrhrrtrinart.cra n
The following is required iTtformation - an incomplete application will not be accepted. Please print legibly (in ink) or type.
PROPERTY•• •
'
SITE ADDRESS L ire- o,4-�_ Fr-j er. d +1 SUITE/UNIT #
a
ASSESSOR'S TAX/PARCEL # '7 2 S C) - D 3 L( LOT SIZE (sfi
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) e L r" fc, r K '~� W"p 5� L a Ili , ? u S _
(Aaach separate pagefo Lengthy Legal descrlptlorV
PROJECT• •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only
e; 0.f 4S C t�,`
PROJECT NAME (Name of Business or Owner Last Ntamel E CCU e �� r t. 1l.� a S ? tt I k u S
PROPERTY
OWNER
CONTRACTOR
COPY of cud required
with tack appllcadon
APPLICANT
PROJECT
CONTACT
LENDER
PRIMARY PHONE
rrW �j I FY^"tea '' • aa^TT� t:,'� r `J
�1n4�5� crTl�{�� 11�iLi4u�1 (L1..zs) Z5o - io5o
MAILING ADDRESS l CITY, STATE, ZIP E-MAIL ADDRESS
'?)I-1 oo Cclf l�`Ov.
`COMPANY NAME
V � 1 ve- �nn c ,
APPLICAN1T NAME
C'1 S k" K
C
OFFICE PHONE p p
�v 6
J 111
I In GI ,2_
(Z,Q ) - / O O V
MAILING ADDRESS y
CITY, STATE, ZIP
4cornc,
CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
l�7
FAX NUMBER
I L 0000,5S-coo - a3L- ).Ll3I
( ) -
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE
E-MALL ADDRESS
S 111T-r" �--s \3 6 o-,r 1 r /z /o �
i
COMPALVIY NAME_
'-�V-e S s ew. ,
APPLICANT NAME
C k-OA C V\ k
OFFICE PHONE
(ZS3) 926
MAILING ADDRESS
)106- s�I +} ,� \=cs�
CITY, STA , ZIP
t c„nn�, W/4--
CELL PHONE
RELATIONSHIP TO PROJECT
10
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent i(Other o 3 e e
( ) -
NAME 1- /` PRIMRY PHONE E-MAIL ADDRESS
1� Y1�11j� l.. arAe.1 (.�r]� ) �� J - .L �•�1n� llrr�r��Pr-�tn,..'�-1.-L-. r.s _. r.�•
NnasE Per RCW 19.27.095:
Lender information is required if project value exceeds $5,000
MAILING ADDRESS CITY, STATE, ZIP PHONE
( 1
EXISTING USE 1 � uO
PROPOSED USE _ (� + ( C f-
EXISTING ASSESSED/APPRAISED V UE $ Cl 11
S O
VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING?
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? YES
WATER SERVICE PROVIDER
kLAKEHAVEN
❑ HIGHI.INE
❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER
o LAKEHAVEN
❑ HIGHLINE
❑ PRIVATE (SEPTIC)
❑ NO
PROJECT••• AREAS
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
FT.
TOTAL
I SQ. FT.
BASEMENT
_SQ.
FIRST
SECOND
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS eraeru�a
PROP-10 rorN
imnte®rMo 9P
imnt PftOPd5PV SP
TOTAL 6F
"NEW HOMES ONLY"* NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type ofjixture to be installed or relocated as part of this project. Do not include existing j&tures to remain.
MECHANICAL
Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS PIPE OUTLETS WOODSTOVES
BBQS
FANS
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
HOODS (commriat)
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS TAG SETS
REFRIG. SYSTEMS
BATHTUBS (or Tub/Shower Combo) LAVS (BathroofnSinks) URINALS MISC (Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS (Toua)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
I certify under penalty of perjury that the irformation furnished by me is true and correct to the best of my knowledge, and further, that l
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, andfiled 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
�In"4, F t fe)
) 2-II ` O7
d5lgna[urel ('title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect Other 2 Q e -e-
FOR OFFICE USE ONLY
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑ YES ❑ NO
BASIC PLAN? o YES
o NO
ZONING DESIGNATION
CHANGE OF USE? ❑ YES
❑ NO
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
UP/SEPA/SU? ❑ YES
❑ NO
PLATTED LOT? o YES ❑ NO
DEMO PERMIT REQUIRED? ❑ YES
❑ NO
Bulletin #100 —January 1, 2007 Page 2 of 4 k\Handouts\Permit Application