06-103853t RECEIVV) I
CITY OF
Federal Way AUG o 4 20 6PERMI
COMMUNITY DEVELOPMENT SERVICES
33325 8m AVENUE SOUTH • PO BOX 9718 I C A Z
FEDERAL WAY, WA 98063.9718 CITY OF FED
253.835 -2607• FAX 253.835 -2609 �` +My C)'N
unyw.cituoflederaiwn u.mm ou L.LJ
The following is
- an
a- -'A -:L v a- _5 <-a
SF MF CO ME EL PL DE ENO
not be accepted. PIease print legtbZy (in ink) or type.
SITE ADDRESS % 3 t hG�tkwi UITE /UNIT #T / V I
ASSESSOR'S TAX /PARCEL # 6 S Z 9 S _ LOT SIZE (sfl
O 1 L a
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
/Attach separate page for bngthy legal descrotioN
PROJECT • •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING � FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlul
ADD I a ELOC -6-rE - rAA1MAfLfi -7Z,S' F-OA j1 /74t4bA E- xjb/44-•3.S "A&- rr4V/24N7- -rd,
PROJECT NAME (Name of Business or Owner Last Name)
PEOPLE •• •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
NAME
D P&S AI IAI L L C
PRIMARY PHONE
(4Z5) W 7- Z 7a�
MAILING ADDRESS
9/S' //8 r" AvF sF
CITY, STATE, ZIP
UZ.LFvuE
COMPANY NAME
f,dTRioT /!y'� /��oTbZT�oA/
APPLICANT NAME
6-vAW ,3o(a&4Att--El�
OFFICE PHONE
(Z53) 9Z6 -Z24
MAILING ADDRESS
z 70 -7 70 Tw ,dvS` F
CITY, STATE, ZIP
�'�corr 4 , ►N+d 9847'
CELL PHONE
( ) _
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
1 9 -9 /- / _o / _f g 8 -B L 1Z / 31 / oG
FAX NUMBER
(Z53)gzz - 615-0`
CONTRACTOR'S REGISTRATION NUMBER (copy of card required with each application) EXPIRATION DATE
A -rP r F Po 9 c r /z /3l /06
COMPANY NAME
-.T Z -Z A i3 o V9-
APPLICANT NAME
OFFICE PHONE
( ) -
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe) SZJ 4+ C-oN!'24C7
FAX NUMBER
( ) -
NAME
�,SA A41, :rIA4
PRIMARY NE
Zs3 PHONE _ zzl o
E-MAIL ADDRESS
PerRCW19;27095 Lenderiryformattonis i,
requiz) tzj f proje'# vafiuo ezceeils«$S x001
NAME
MAILING ADDRESS
CITY, STATE, ZIP
EXISTING ASSESSED/ ASSESSED /APPRAISED VALUE $,
PROPOSED USE , ,El TQUl) ANT
VALUE OF PROPOSED WORK $ .3 ;9 0 d
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
DISHWASHERS
SINKS
FIRST
Z 3 30
WASHING MACHINES
SECOND
LAVS (Bathroom sinks)
VACUUM BREAKERS
THIRD
-.CHANGE OFBUSE? . r,=
'� 1'ES'." ntNOr w,<'
ADDR"REQUIRED?
ESS:
FOURTH
o YNEW ES
ADDITIONAL FLOORS (DESCRIBE)
PLATTED;LOT?
o YES dNO
DECK (COVERED ?)
❑:YES
n1V0
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
87QSTI11G
PROPOSED
TOTAL
`:'TpTAV?X=TRiG'BF
!,TOTAL PROPOBEO:BF
'TOTALBF
* *NEWHOMES 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 $ '31 400
AIR HANDLING UNITS EVAPORATIVE COOLERS
BBQS FANS
BOILERS FIREPLACE INSERTS
COMPRESSORS FURNACES
DUCTS GAS PIPE OUTLETS
PLUMBING
❑:ALTERATION
BATHTUBS (or Tub /shmerCOmbo)
SHOWERS
DISHWASHERS
SINKS
GAS PIPE OUTLETS
SUMPS
WASHING MACHINES
URINALS
LAVS (Bathroom sinks)
VACUUM BREAKERS
GAS LOGS REFRIG. SYSTEMS
HOODS (commercial) WOODSTOVES
RANGES 3.5" MISC (Describe)
GASWATERHEATERS F / ,3E SP%3 /NXLFRS
WATER CLOSETS rroiieq _
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
MISC (Describe)
I certify under penalty of perjury that the is armation 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, including its officers and employees, upon the accuracy of the tr1formation supplied to the city as a part of
this application.
NAME /TITLE �—�' �y - -� � DATE
(Signature( (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent kContractor ❑ Architect ❑ Other_
8. 3, Zoo G
❑'NEW ❑- ADDITION
❑:ALTERATION
Ei REPAIR o.3`ENANT IMPRQ�IEMENT
- BUILDING :SHELL ONLY?
a "YES n NO
aR SIC.PLAN?
3'ES,.
;ZONINGMESIGNATION
-.CHANGE OFBUSE? . r,=
'� 1'ES'." ntNOr w,<'
ADDR"REQUIRED?
ESS:
❑`:YES ❑':NO
o YNEW ES
n;NOr,`
PLATTED;LOT?
o YES dNO
ZEMO.PERMIT REQUIRED?
❑:YES
n1V0
Bulletin 4 100 — August 19, 2004 Page 2 of 4 k\Handouts\Permit Application