08-105790 w ,
CITY OF A R r o 5- 7 qo
Federal Way - -
COMMUNITY DEVELOPMENT SERVICES
DEC 0 5 ZOOS PERMIT SF' MF CO ME EL PL DE E FP
33325 8TH AVENUE SOUTH•PO BOX 9718 pi IN-W ATI O N TD
/ /
FEDERAL WAY,WA 98063-9718
253-835-2607•FAX 253-835-2609 ���
www.cit yoffederaluciTy ./
N �
The following is 11 required infoi Dia.-an incomplete application will not be accepted. Please print legibly(in ink)or type.
'31. 1.-)b C / //• PROPERTY INFORMATION'Sr SITE ADDRESS_ 2 J S . 3-7-7 'h Ili� i � SUITE/UNIT#_
b
ASSESSOR'S TAX/PARCEL# 7 2 / 2- O 02_2_1 LOT SIZE(sjj
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 El ENGINEERING Cad FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
TO 0.35�Au F12E 9L Ter1 lit=v( c 5 F7 !v0,1-iki 7
111API zc 114 CiVr
PROJECT NAME(Name o f Business or Owner Last Name) D t u e y (3 IA L I)/Ai U -P A N u"K)C'(A T-cy( 14 0,9
• PEOPLE INFORMATION
PROPERTY PRIMARY PHONE
OWNER JCvR I ' u10) Iv (y// )K r y
- eievot
MAILING ADDRESS , STATE.ZIP E-MAIL ADDRESS
(nco 3 -f 3' r bFEES&GuR'1, k)/1
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
( w F)►2 E P ?OreCPC D (312, 3h if-) J (11254 S4 -& 31-id
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
151;00 w0 i bOV(t.0 2Ei)MO0) RD lucooiNVILLE wl�,gym. (`? ) 7%' -< 327
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
CID- Dl ~ I D `j ~00 --13L /Zj lj2W ( ) -
O CTOR'S REGISTRATION ER EXPI TION ATE E-MAIL ADDRESS
LOS(OFP°V 6 M3 bqs'lpo5c0f(✓e.com
APPLICANT COMPANY NAME APPLICANT NAME I OFFICE PHONE
(09-0 F t rL E✓ P)zoT EGT1 b N r3fZ4& )l iu M OoLq (4j5 ) to€(, - 6 3L10
MAILING ADDRESS p5C)p0 1,.c.)LO, 1,util Lc.LG I reeDisfotalEITY.STATE,ZIP CELL PHONE
Fir) Ate- Su ire g ido tr)bopituvLLt IA,A- gst:7Z (sot, ) 71-lx, - T3 7-'7
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑Tenant ❑Agent ❑ Other ( ) -
PROJECT NAME PRIMARY PHONE E-NIAR ADDRESS
CONTACT UebfibliA F Eg eK
(fJ26) 27z- b2(c 1 j A e f 5a eri i n, ism
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 3 / 12-' 0"
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)
II
. •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL MISTING SF TOTAL PROPOSED SF TOTAL SF
**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
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)commrre+.))
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS or Tub/shower Combo) LAVS)eam,00m sn,ko) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Touoq
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 i//rG"%�J/� ' DATE /Z/ U
Property 0 r and/or Authorized Agent
o NEW ❑ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION CHANGE OF USE? u YES ❑NO
NEW ADDRESS REQUIRED? o YES u NO UP/SEPA/SU? o YES ❑NO
PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? ❑YES o NO
Bulletin#100—August 16,2007 Page 2 of 4 k\Handouts\Permit Application