04-102069 (2)RECEIVED,'
Y4deraiWay mAY 2 4 2004 PERMIT
COMMUMTYDEVELOPMENT SERVICES
33530 FIRST WIVYSOUTfi . PO BOX 99iBp p L I AT I N
FEDERAL WAY, WA 9800.M O F DEftAI
258-661.4115• PAK2s3-G6I•�li 6ijILiDING DF
vfww. rx iledrmlruau. mm
The following is
- an
SF MF CO ME EL PL DE EN FP
will not be accepted. Please
or
SITE ADDRESS I C1 l 1 �(�� JO ��� SUITE/UNIT # 9
ASSESSOR'S TAX/PARCEL # AD--D LOT SIZE (sf) I S
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) [? 'f 1� L I 1 �_ RT I. (1_) 1Z p- C, i (0 ), I -
(Attach separate page for lengthy legal cl—ription) S ` A PH _E M (-, k ) 7.1a L-
TYPE OF PERMIT IV BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
�e ► ..�� �L > %Ahzx- : P!:t Lt c&1� r�_ :JLAZ� D W t M ID
PROJECT NAME (Name of Business or Owner Last Name)
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
EXISTING USE
N E PRIMARY PHONE
n `fir i
MA Li ADD ES I STATE, ZIP
r
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
( 1 -
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
(
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
FAX NUMBER
/ )
--
(
-- — B L
ATN NB
CONTRACTOR'S REGISTRIOUMER (copy of card required with each application) EXPIRATION DATE
C'SPANY NAME
k,
APPLICANT NAME
OFFICE PHONE -
G%-%e- Vs6004,
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
(
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe) C� �Je� IJ
40t, )'n � Q - 19-3 -1
N E PRIMARY PHONE n E-MAIL ADDRESS
Per RCW 19.27.0 5. Lender information is
NAME
required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
EXISTING ASSESSED/APPRAISED VALUE $
PROPOSED USE
VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 11 HIGHLINE 11 PRIVATE (SEPTIC)
PROJECT FLOOR AREAS
I
AREA DESCRIPTION
EXISTING S . FT.
PROPOSED S . FT.
TOTAL
BASEMENT
FIRST �
C\ �
J
� r
�j
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS?
TOTAL EXISTING
TOT,u,neoronm
TOTAr.sXUrMO.umraOPOSM
**NEW HOMES ONLY** NUMBER 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.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS
EVAPORA E C OLERS
REFRIG. SYSTEMS
BBQS
FANS
S (commercial)
�G:AS
WOODSTOVES
BOILERS
FIREPLACE N
ES
MISC (Describe)
COMPRESSORS
FURNACES
ATER HEATERS
DUCTS
GAS PIPE ❑
F
PLUMBING
BATHTUBS (or Tan/Shower combo)
SHOWERS
WATER CLOSETS (Toilet)
MISC (Describe)
DISHWASHERS
SINKS
DRINKING FOUNTAINS
GAS PIPE OUTLETS
SUMPS
RAINWATER SYST
WASHING MACHINE
URINALS
HOSE BIBBS
LAVS Bathroom Sinks
VACUUM BREAKERS
ELECTRIC WATER HEATERS
I certify under penalty of perjury that the information 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, inctccd"g it officers and employees, upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE DATE
i a ure) (Title)
RELATIONSHIP TO PROJECT ❑ Owner 4gent ❑ Contractor ❑ Architect D Other P C N� U-Nctic P_1`
FOR OFFICE USE ONLY
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES ❑ NO
BASIC PLAN? ❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE? o YES
❑ NO
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
UP/SEPA/SU? ❑ YES
❑ NO
PLATTED LOT? ❑ YES ❑ NO
DEMO PERMIT REQUIRED? ❑ YES
❑ NO
Bulletin # 100 — March 30, 2004 Page 2 of 4 k\Handouts — Revised\Permit Application
LICENSE DETAIL INFORMATION Form Page 1 of 1
STATE OF WASHINGTON
DEPARTMENT OF LABOR AND INDUSTRIES
Specialty Compliance Services Division
P. O. Box 44000 Olympia, WA 98504-4000
THE RESULT OF YOUR INQUIRY FOR LICENSE NUMBER SELECTED IS:
LICENSE DETAIL INFORMATION
Current Filter: None
Registration# or License HOUSIT*215KD
Name HOUSING AUTHORITY/CTY/KING, TH
Address
ATTN: TRUDY PARFINSKI
Address
600 ANDOVER PARK W
City
SEATTLE
State
WA
Zip
981883326
Phone Number
2065741100
Effective Date
5/4/1979
Expiration Date
3/1 /2005
Registration Status
ACTIVE
Type
CONSTRUCTION CONTRACTOR
Entity
CORPORATION
Specialty Code
GENERAL
Other Specialties
UNUSED
UBI Number
600260524
* * *VIEW CROSS REFERENCE FILE FOR THIS LICENSE*
* * *VIEW PRINCIPAL OWNER(S) FOR THIS LICENSE* *
* * *VIEW CONTRACTOR BOND/SAVINGS INFORMATION * * *
* * *CHECK INQUIRY FOR SUMMONS AND COMPLAINTS*
* * * VIEW CONTRACTOR INSURANCE INFORMATION * * *
New inquiry by CITY, NAME, PRINCIPAL OWNER NAME, LICENSE, UBI NUMBER , check the
L&I Contractor Industrial Insurance Premium Status or return to the L&I ConstrucTion Cowliance Hme— age
https://wws2.wa.gov/lni/bbip/TF2Fonn.asp?License=HOUSIT*215KD 4/29/2004