05-106318�E EIVED
cm or ✓ -1 ( (o 3 ( 9�
Federal Way PERMI'PEC 12 2005
SF MF CO ME EL PL DE E FP
COMMUNITY DEVELOPMENT SERVICES
333256835 -26 7- FAX253 PO BOX 9718 APPLI CACrj6Q ERAL W -
FEDERAL WAY, WA 98063 -9718
253W1vU, 07•FAX253-835-2609 G DEPT
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PROPERTY INFORMATION
SITE ADDRESS - .91A M SA.0w 34474 WAY _ SUITE /UNIT # 130
ASSESSOR'S TAR /PARCEL # -Q— -Q— 9_ A— 0- 4�- - -10- _LL C— LOT SIZE (sn S •J SQ - Fi
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) 6EE .A -v'r A Ck4F Q
(A(fach sePara[e P�Jel kgWj legal desc�lpflwti
PROJECT • '
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING Z FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION IProuide detailed description of work included on this nermit OHIO
PROJECT NAME (Name of Business or Owner Last Name) 'Ro Lit e4 m ei.la
PEOPLE •-
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
NAME
E - ft*D PkPfQ'>ry za)v T
PRIMARY PHONE
(4153) 874 - 41e375
MAILING ADDRESS
070 f^ E = CaP�tE
CITY, STATE, 21P
LA FA fr G
COMPSqa4fEi) SYMMS LEC
APPL oij AMMA tJA�b
AJ
OFFICE PHONE - 64�
(eXl'V -� )
MAILING ADDRESS
:b. Box '731 ZZ7
CITY, STATE, ZIP
Y)k 953-4
CELL PRONE
(&VS3) 6s, - IoLodi
CITY GOF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
-L 1--51 - I U 4 1 1 �L -B L 1Z /3k /OS
FAX NUMBER / jp,
1 '11A ,%69
F3
CONTRACTORS REGISTRATION yNUMBER (copy of card required with each application) EXPIRATION DATE
i L AI 1 A L•1[ S k
COMP.AMf NAME
F"IS"ACED �Y. E LC
APPLICANT NAME
KZ
OFFICE PHONE
(2.53) oq&
MAILING ADDRESS
P0.20% r -p
C STATE, ZIP
CELT, PHONE
(2e3) Gs
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent � Other (Describe)j<L;*A k(Z ACW9
FAX NUMBER
(ZSI) 84t.* - �&%
NAME M yl�LA 9.i
(`�`31 PHONE
fJ ,4(d - �ie`�""
fb1:ItAIA Et5ymogsiLc
Per RCW 19.27.0135: Lender information is "
.,required . if project value exceeds. $6,000
NAME
MAILING ADDRESS
CITY, STATE, ZIP
EXISTING ASSESSED /APPRAISED VALUE $
SPRINKLERED BUILDING? y� YE.S El NO
WATER SERVICE PROVIDER (( /yam \LAKEHAVEN
SEWER SERVICE PROVIDER ❑ LAKEHAVEN
PROPOSED USE
VALUE OF PROPOSED WORK $_ _67S • 00
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? (o YES
❑ FDGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ HIGHLINE ❑ PRIVATE (SEPTIC)
.min
PROJECT FLOOR AREAS
AREA DESCRIPTIOIN
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
❑ NEW o.ADDITION
`: o ALTERATION -
c REPAIR ❑ TENANT IMPROVEMENT
FIRST
BUII DING SHELL ONLY ?,
❑ YES a NO
SECOND
❑ YES
n NO
ZONING DESIGNATION
THIRD
CHANGE OF USE?
❑ YES
FOURTH
NEV ADDRESS REQUERED? ❑
YES ONO
ADDITIONAL FLOORS (DESCRIBE)
o YES
❑ NO
PLATTED LOT? o YES o NO
DECK(COVERED ?)
DEMO PERMIT REQUIRED?
n YES
o NO
GARAGE ❑ CARPORT ❑ -
NUMBER OF FLOORS
extsnrva
raoros®
Toro
`TOrer.xnsTVra er
Tore(MOPas® W
Tmr sr
" NEW HOMES ONLY " NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
of Mechanical Work $_
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS for nn /mower comto�
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS (Hathmom Si csj
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS (CoemmmU)
RANGES
GAS WATER HEATERS
WATER CLOSETS rr cn o _
DRINHING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
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 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 information supplied to the city as a part of
this application.
NAME /TITLE
RELATIONSHIP TO PROJECT ❑ Owrier ❑ Agent (A Contractor ❑ Architect ❑
0 122 /0S
F61t OFFICE
USW ONLY
❑ NEW o.ADDITION
`: o ALTERATION -
c REPAIR ❑ TENANT IMPROVEMENT
BUII DING SHELL ONLY ?,
❑ YES a NO
BASIC PLAN?
❑ YES
n NO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
❑ NO
NEV ADDRESS REQUERED? ❑
YES ONO
UP /SEPA/SU?
o YES
❑ NO
PLATTED LOT? o YES o NO
DEMO PERMIT REQUIRED?
n YES
o NO
Bulletin #1100 — January 7, 2005 Page 2 of 4 k \Handouts\Permit Application