07-100653city OF
0 too 53
Federal Way RECEIVE6 PERMIT�
COMPM'#,M DEVELOPMENT SERVICES MF CO ME EL PL DE E /1721�
33325 8M A VENUE SOUTH - PO BOX 97) 8 IQPJ
FEDERAL WAY, WA 98063-97189FEB 0 6 NAPPLICATION
.253-835-2607- FAX 253-835-260
Ls�_U). (�! JI&C de -r() Iwn it. com
01TYoF_ u RALWAY
The following is reqIbeww". -an incomplete application will not be accepted. Please print legibly (in ink) or type.
PROPERTY INFORMATION
SITE ADDRESS (Lbe*V. SUITE/UNIT #
ASSESSOR'S TAX/PARCEL #
_7 —0 LOT: SIZE (so If
LEGAL DESCRIPTION (e.g. Aa�e Estates, Lot 1)
fAttach xqp�t. pagcfw lengthy legal descriptioN
PROJECT INFORMATION
TYPE OF. PERMIT 0 BUILDING 11 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL D ENGINEERING XFIRK PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this Permit only)
SefL\NW—LL,�A V�&,TozA_ AU I L.0) -it—
PROJECT NAME (Name of Busines or Owner Last Nam 65,4,41V I EE
PEOPLE INFORMATION
PROPERTY
OWNER
NAME
PRIMARY PHONE
(Z-;7 )9 Yto '7 6 6 ?-
OFFICE PHONE
( 2S3 )-I?-&
MAILING ADDRESS
;Z_�o _? _
MAILING ADDRESS
CITY, STATE, ZIP
E-MAIL ADDRESS
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
KXVIRATION DATE
1-7NO,
?'98'
-.'00 -6L
-3 -7
CONTRACTOR
COPY f e-4 -qul-d
with each appHeation
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
COMPANY NAME
ea'-�vtwyr �Ixi
Bko-reenotJ4 lAkc-
APPLICANT NAME
1Dh<_LA
OFFICE PHONE
( 2S3 )-I?-&
MAILING ADDRESS
;Z_�o _? _
VL-.;; . C7
CITY, STATE, ZIP
X,
CELLPHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
KXVIRATION DATE
FAX NUMBER
?'98'
-.'00 -6L
-3 -7
Per RCW 19.27.095:
Lender irtformation is required if project value exceeds $5,000
CONTRACTOR'S REGISTRATION NUMBER
EXPIRATION DATE -
E-MAIL ADDRESS
FiO
0 9 9
COMPANY NAME
&O—T -rIVAJ I K
eC
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS .
..2)0"7 76 V #We'
CITY, STATE, ZIP
'IN
CELL PHONE
RELATIONSHIP TO PROJECT
13 Architect 13 Tenant .13 Agent Other �5WQ 1( , tOL ro.XT e 4C TcA-
FAX NUMBER
NAME
PRIMARY PH E
12 6 2
E-MAILADDRESS
NAME
Per RCW 19.27.095:
Lender irtformation is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING ASSESSEDIAPPRAISED VALUE
,SPRINKLERED BUILDING? 0 No
WATER SERVICE PROVIDER 6KLAKERAVEN
SEWER SERVICE PROVIDER o LAREHAVEN
PROPOSEDUSE
VALUE OF PROPOSED WORK $ -70C>. !ML
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES 0 NO
0 HIGHLINE o TACOMA 0 PRIVATE (WELL)
13 HIGHLINE 0 PRIVATE (SEPTIC)
r
AREA
EXISTING PROPOSED
Sc SO. FT.
ro�dhk
TOTAL
50. FT.
ADDITIONAL FLOORS (DESCRIBE)
DECK (D COVERED OR D. UNCOVERED?)
GARAGE 11 CARPORT 0
NUMBER OF FLOORS EXISTINO PROPOSMV TOTAL TOTALJ TM Sr 7.0 7AL PRC I WOSAV Sr TOTAL 67
—NEWHOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each I type offi�xture to be installed or relocated as part of this projecL Do. not include existing fixtures to remain.
Value Of Mechanical Work
'A
(A Cop OF BID -OR ESTIMATE MUST BE INCLUDED W7THAFPLJ(_ TION)
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS PIPE OUTLETS
WOODSTOVES.
BBQS
FANS
GAS WATER HEATERS
MISC (Describe)
BOILERS
FIREPLACE INSERTS
HOODS (cmnnerciaA
0 NO
COMPRESSORS
FURNACES
RANGES
UP/SEPA/SU? a YES
DU.qSi.
GAS L66 SETS
REFRIG. SYSTEMS
PLUMBING
o NO
BAT14TUBS (or Tub/sh�r combo*)
LAVS pathmom sinks)
URINALS
MISC (Describe).
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS rr.nq
ELECTF�IC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
Z certtfy under.penalty ofperft" !hat the information furnished by me is true and correct to the best of my knowledge, and further, that Z
am authorized by the owner of the above p . remises to perform the work for which the permit application is made. I further agree to hold
harmless the City of Federal Way cis to any claim (including costs, expenses, an� att*Mey3* fees incurred in the investigation and defense of
such claim), which may be made by any person, including the undersigned, andfiled,against the City ofFederal 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, tra— -D, ATE Z-
(Signat&ej Intle) -
RELATIONSHWT�PR�JE&. 0 Owner 0 Agent %<Contractor o Architect o Oth
13 NEW c ADDITION
0 ALTERATION
o REPAIR o.TENANT IMPROVEMBNT.
BUILDING SHELL ONLY?
o YES o NO
BASIC PLAN? o YES
u NO
ZONING DESIGNATION
CHANGE OF USE? 0 YES
0 NO
NEW ADDRESS REQUIRED?
o YES NO.---
UP/SEPA/SU? a YES
o NO
PLATTED LOT?
_0
C) YES ONO
DEMO PERMIT REQUIRED? 0 YES
o NO
Bulletin # 1.00 —January 1, 2007 Page 2 of 4 k4landoutAPermit Application
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
SQ. FTO
BASEMENT
FIREPLACE INSERTS
COMPRESSORS
FURNACES
FIRST
GAS PIPE OUTLETS
LAVS jBath sinks)
VACUUM BREAKERS
SECOND
-HISANGE�,OF
YES
THIRD
d
FOURTH
a YES
0 NO
ADDITIONAL FLOORS (DESCRIBE)
DEMO�PER11ftRkQU4"?.
0 YES
DECK(COVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS
Z=MNQ
PROPOSM
TOTAL
TWAL_
TOTAL PROPOUD SF
TOTALS - F
**NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MFC114AWAL
Value of Mechanical Work C7
I f
AIR HANDLING UNITS
EVAPORATIVE COOLERS
BBQS
FANS
BOILERS
FIREPLACE INSERTS
COMPRESSORS
FURNACES
DUCTS
GAS PIPE OUTLETS
BATHTUBS for Tub/ ShoC�boj
SHOWERS
REPAIR
t
DISHWASHERS
SINKS
GAS PIPE OUTLETS
SUMPS
WASHING MACHINES
URINALS
LAVS jBath sinks)
VACUUM BREAKERS
GAS LOGS
HOODS
RANGES
GAS WATER HEATERS
WATER CLOSETS fr.iL-tj
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describel
MISC (Describe)
I certify —der 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 ftncluding costs, expenses, and atterneys'fees incurred in the investigation and defense of
such claimh 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 offlcers and employees, upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE
RELATIONSHIP TO PROJECT 0 Ovimer 0 Agent � Contractor o Architect 0
DEC 0 8 2006
Bulletin #100— January 1, 2006 Page 2 of 4 k�Handouts\Perrnit Application
�k'
REPAIR
t
Y.,
Z�"
0 YES
o NO
N
-HISANGE�,OF
YES
a NO
d
a YES
0 NO
0
DEMO�PER11ftRkQU4"?.
0 YES
0 NO
Bulletin #100— January 1, 2006 Page 2 of 4 k�Handouts\Perrnit Application