04-100891Federaali Wa PERMIT APPLICATION
i1AR 1 6 2004
For O>L« U.(a +V:Y
The followinq is
SITE ADDRESS:
Qa -9 �eI-
- an incomplete gppUcation will not be
F=/0
COM=T DEVELOPMENT SERVICES
33530 FIRST WAY SOL71I • PO BOX 9718
FEDERAL WAY, WA 98o63 -9718
2536614115• FAX: 253- 661 -4129
tmumcitw6edemlwau mm
TD:
Please Tint le ibll (in ink) or
SUITE /APT # .
ASSESSOR'S TAIA 991V �O!t'90 -� / I _ SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTION (e.g.: Acme Estates, Lot 1) / G D
(Attach separate page for lengthy legal descnptlon)
PROJECT 1 •- •
�\ I`a
TYPE OF PERMIT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING�FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlul:
Zd2f ,6ZL4_ 6 " 6AZE
%��'lss Gl /i67� >'L' �l�'f� K j o ,�iii,l,•/��i�G � r�V G >✓ /n/Lc�.t/�jNC�
PROJECT NAME (Name of Business /Owner Last
fry
PROPERTY
OWNER
NAME:
O O 6-111G
PRIMARY PHONE:
e;Z '7- %4 1
-9343
MAILING ADDRESS (STREET ADDRESS;):
3 33 Cs4,//�sxJ �/�vT
CITY, STATE, ZIP
K / 3
CONTRACTOR:
LENDER:
(If P —Posed value > $5,000)
APPLICANT:
NAME I �/� 16A A f'p
4wi>
COMPANY
OFFICE PHONE:
(253 )534
-9343
G sup l
.- -:,'
RELATIONSHIP TO PROJECT: ,,,
13 ❑ Architect Tenant Other (Describej.L7z// �t-� I
x'41- LK
FAX NUMBER:
MAILING ADDRES (STRE ADDRESS;):
o�xy „ ,1�£Er
CITY, STATE, ZIP
8�
CELL PHONE:
t Zs3)6d�
- X70,5
j
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: EXPIRATION ATE:
FAX NUMBER:
------- - - - - -_ l /
czs3)S36
-q�9Z
CONTRACTORS REGISTRATION NUMBER:
EXPIRATION DATE:
(copy of card required with each application)
NAME: DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS;): CITY, STATE, ZIP
NAME:
FTC �c�
COMPANY
oe a� �/�
OFFICE PHONE:
00; 0 3 3- z41,50
MAILING ADDRESS (STREET ADDRESS):
epX 0'
CITY, STATE, ZIP
ieT 9P -e�'T
EVENING PHONE:
tom) S� l - / 3 15
RELATIONSHIP TO PROJECT: ,,,
13 ❑ Architect Tenant Other (Describej.L7z// �t-� I
x'41- LK
FAX NUMBER:
r12
CONTACT PERSON FOR THIS PROJECT: ❑ Property Owner Contractor (3 Applicant E -M IL ADDRESS:
G�N1
DETAILED I r NG INFORMATION
EXISTING USE:
EXISTING ASSESSED /APPRAISED VALUE $.
SPRINKLERED BUILDING? ❑ YES ❑ NO
PROPOSED USE:
VALUE OF PROPOSED WORK: $� O O
FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED ?: ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING S . FT.
PROPOSED S . FT. TOTAL
BASEMENT
BUILDING SHELL ONLY?
❑ YES , -o NO
FIRST
❑ YES
o NO
ZONING DESIGNATION:
SECOND
CHANGE OF USE?
❑ YES
THIRD
NEW ADDRESS, REQUIRED?
❑ YES o NO
FOURTH
o YES
o NO
PLATTED LOT?
ADDITIONAL FLOORS (DESCRIBE)
DEMO PERMIT REQUIRED? '
❑ YES
DECK(COVERED ?)
GARAGE /CARPORT
HOW MANY FLOORS?
TOTAL EXISTING
TOTAL PROPOSED
TOTAL EXISTING AND PROPOSED
1.*.NEWHOMES ONLY" NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
Indicate number of each type of fixture that is to be installed or relocated as part of this project. Do not include existing fixtures to remain.
11EC L4A7CAL
Value of Mechanical Work $
-AIR HANDLING UNITS
BBQS
BOILERS
_COMPRESSORS
DUCTS
PLUMBING
BATHTUBS (or Tun /sho�comno)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS (Bathroom Sink
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS (Commercial)
RANGES
GAS WATER HEATERS
WATER CLOSETS (Toaeq _
DRINKING FOUNTAINS
RAINWATER SYS
HOSE BIBBS
ELECTRIC WATER HEATERS
]ISCLAiMER /SIGNATURE BLC
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
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 Feder-at 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, u on the accuracy of the information supplied to the city as apart of this application.
NAME /TITLE: FL DATE:
(Sign re) (Title)
RELATIONSHIP TO PROJECT: ❑ Property Owner ❑ Applicant Cl Contractor ❑ Architect ❑
❑ NEW ❑ ADDITION
o ALTERATION
❑ REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES , -o NO
BASIC PLAN?
❑ YES
o NO
ZONING DESIGNATION:
CHANGE OF USE?
❑ YES
o NO
NEW ADDRESS, REQUIRED?
❑ YES o NO
UP /SEPA /SU?
o YES
o NO
PLATTED LOT?
❑ YES o NO
DEMO PERMIT REQUIRED? '
❑ YES
o NO
flullc0n 4li