08-108065 ,
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CITY F RECEIVE. var _ ( c25- os.
Federal Way PERMIT
' COMMUNITY DEVELOPMEIVT SERVRKT 2 4 Z008 SF MF CO ME EL PL DE EN(U)
33325 tim AVENUE SOUTH•PO BOX
PLICATION 'ID
FEDERAL WAY,WA 98063-9718
253-835-2607.FAX 25$57-2CF_ FEDERkg-‘Y / /
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The following is reguiredCaAnation-an incomplete application will not be accepted. Please print legibly(in ink)or type.
Ell PROPERTY INFORMATION
SITE ADDRESS_ I ?s-5— 5(-e-) Cce-w t NS Dr SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# ( CI 2 1 oy - ic, L 7 LOT SIZE(4)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) 1•4ve.-- R.e.-,Secr-ve,s (4-9 4-5 •Bvt 1 -7
(Attach separate page for lengthy legal descriphon)
1.1 PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING aimE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) t.
k42._p ka.ty c. r e aA.c4....r LA.J. p zt..t,,,eA Sa.A.A4...c.4_03 e._€--(-._ elii-e-e- ti ri
, PROJECT NAME(Name of Business or Owner Last Name) --61c05 (7 —71,,e_ r-e., ..d.rv e_,s
ill PEOPLE INFORMATION
PROPERTY NAM PRIMARY PHONE
OWNER ST74 e__ -.e., e/V‘V e__,S (2..s-3) n -agg I
MAILING ADDRESS CITY,STATE,ZIP Loo E-MAIL ADDRESS
19-5 5 U.) easm.pus Dir -Pe6149/64,1061
CONTRACTOR ROMPANY NA,ME _j_., APPLICANT NAME OFFICE PHONE
re-(9-i-e(....H Olikick CV le14444-1.)V1 ■CC•11,1 ---ri)(lkiLl (11 )7rei -
MAIL)JG ADDRESS C ,STATE,ZIA CELL PHONE
I (e SO 14,6 Att e. W 11.ainviwemz( c C it-L'1, (019‘) 570
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATI N D FAX NUMBER
15 - 9q - (as-1(0.t-oo — 3 L- I 2/3/ zoor (v_s-) 72e( -G 3 i 7
1
CONTRACTOR'S REGISTRATION NUMBER EXPIRATIO DATE E-MAIL ADDRESS
P t o-n E__c_a- .1/es-L. k
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
-
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
_
( )
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent 0 Other ( ) -
PROJECT "115//v.t Luit-orni/A. PRIMARY PHONE E-MAIL ADDRESS
CONTACT (2.ae) SIC -
LENDER NAME ,/.74....., Per RCW 19.27.095:
4.)1 Lender information is required if project value exceeds$5,000
MAILING ADDRESS - CITY,STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE 54,An.r.._ PROPOSED USE
CO 0
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ Zia.00 '
SPRINKLERED BUILDING? 0 YES e 140 FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
a PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
II FIXTURES
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$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(Commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS or Tub/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSIcIS Roses
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best of my
knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with all applicable
City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the issuance of this permit
does not remove the owner's responsibility for compliance with local,state,or federal laws regulating construction or environmental laws.
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, 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.
SIGNATURE DATE /0- 6
Property Owner and/or Authorized Agent
FOR°OFFICE:,USEONLY
o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES o NO BASIC PLAN? D YES D NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES D NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES D NO
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application