06-103852 ) Z_ 96q-3
1
A RECEIVE•
CITY OF Federal way Gn 2006 PERMIT � ( 33CC�� •—LL Y
COMMUMiYDEVEWPMENTSER V 4 �� SF MF CO ME EL PL DE EN P
33325 8Th AVENUE 501771•PO BOX 9718 (s
25 C XW N TD / /
worm aroo(federdwau.owlUILDING DEPT.
The ollowi • is re• ired in ormation-an inco •(ete a..•lication will not be acce•ted. Please •rint le•ibl (in or
■ PROPERTY INFORMATION
0-103 s d 1 ter C �o IA/U s
SITE ADDRESS SUITE/UNIT fi S (C)1„
ASSESSOR'S TAX/PARCEL# 1 9 S Z 1 S - LOT SIZE(4)
O ( -o
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT ❑BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
ADD /77;&GA-r4 s" /Nis LEAS F 91 2 t 1 T /ulba 1 L E `' P% ETA( L_ T,. )•
PROJECT NAME(Name of Business or Owner Last 1+1amej T M v is 1 L E
m PEOPLE INFORMATION
PROPERTY NAME
PRIMARY PHONE
OWNER OILS NW ,. L L G. (4Z5) /7L6-7 - Z703
MAILING ADDRESS CITY,STATE,ZIP
?J 1/8T'X Avg' Ste" 13E--L-4_E vu&---, wA 9800s
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
PII7 4/or -//a E' PA OTEz.T/o A/' EVAN Ba4ii.A /GE727 (X53) 9Z6 -ZZ4c3
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
. 7o7 ;7o-r'N AvE- £ Tc-oNt A ,,:. i4 • 424' (, )'
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER _ EXPIRATION DATE - FAX NUMBER
19 - 9 I - 1 0 1 4 8 8 -B L LZ / 31 / 0 ( ) -
CONTRACTORS REGISTRATION NUMBER(copy of card required with each appiicatioul EXPIRATION DATE
I� k T R ) FP O al 9 G F / Z / 3/ / 06
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
—C.4.Z.- ,.3a v6 ( ) -
MAILING ADDRESS CITY,STATE,ZIP - CELL PHONE
( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑Tenant ❑Agent ❑ Other(Describe) S I1 a CO/'712 4 c.T ( ) -
•
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
L/S4 41L11JT11 4 (Z53) 9Z6 -ZZ90 .
LENDER ,, '" -;i�r )ri euk.--r 1 0.1'.47 Iro`K'7",t _ F 1i• •r, NAME
MAILING ADDRESS CITY,STATE,ZIP
• • - • DETAILED BUILDING INFORMATION •
EXISTING USE --S fi/E7--.L- --. PROPOSED USE . /A/L
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 2' q 0
SPRINW..ERED BUILDING? ❑YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA. ❑ PRIVATE(WELL)
SEW.r;R SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
Iqlz
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
=sr= PROPOSED TOTAL ,�, yr Ni'MeoPOSao BF;+h
NUMBER OF FLOORS + ��� �t_
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
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 Z'7 9 0
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES Z-0 MISC(Describe)
• COMPRESSORS FURNACES GAS WATER HEATERS P E .S•P tJKLER.S
DUCTS OAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS(rmUet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(e.rhmomsinln) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
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 aXT1 ejPA/Ele / PM DATE / . ZOO6
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent Contractor ❑Architect ❑ Other
`I°�t` :aeZ�i10(9.6 .a ? ,VskIH Iel r i,, ,, t� At�i�t i 10 � XrT°� )Yt �t t
';161410(€1 6. P 61+ r�c)�G` 4 c}�x V�( a oh � y 1 Flo,
x 1, ._f, �.-,� r 9 .'� c �l'®�. l il'�yE�1�
4 � �" . �c �} ,Co} rw , r0.)'l 21��"�ir,
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application