07-106482 - 4 •
RESUBMI�
A ED
CITY OF a -- - _t D co C L2,
Federal Way DEC 0 3 2007 PERMIT
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE EN
33325 D AVENUE SOUTH b FE DE RAL'L I C AT I O N TD
FEDERAL WAY.SOUTH 981411-$778, -_-E _
253-835-2607•FAX 253-835-21 1
w z ww.ciltIofederalu•ati.com V ILDING D
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
J�,/y G, 191-1110,---J • PROPERTY INFORMATION (30-1)1
SITE ADDRESS_ 6 U/V 0 / . ( , . .'P�, J, C SUITE/UNIT#-/�
ASSESSOR'S TAX/PARCEL# c'L L ` 11 I`/0 - �� 7 . ' 1 LOT SIZE(sf1 `� ,D -5O`..
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) �/r V(c���\ (-1C- r i
(Attach separate e for lengthy legal description)
El PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING,1-FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detail detailqd description of work included on th' ermit on1
PROJECT NAME(Name of Business or Owner Last Name) \l v(v) i l k or^c VA\ �O
• PEOPLE INFORMATION
PROPERTY NAME WI �/� Cl/�PCv('14e,,, �hV-,- PRIMARY PHONE 11
OWNER vA - 1 �C �C1 � (�QIQ � � --1���
MAILING ADDRESS + - /4I - V lay- CITY,STATE.ZIP E-MAIL ADDRESS
A )u-�'i LOAe �V ae '1 OnVtaa) Jeorace,,
CONTRACTOR CO PANY NAME ¢PPLICANT NAME OFFICE PHONE
<D 5c0 c e Rc Cry C,� \0\.i%5��\1Ac0Thsc3,-"N (4,7 ) (o210 - L0'30
MAILING ADDRESS -i� 3,it) CITY.STATE.ZIP CELL PHONE
I \ 1`�U?c-�x�cv,0 to-QC xr"v^x R - Vea9 Mu��, L.,.A �7 (2LPHO - `'J-'5 2.'4_
/ \ CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
Q LOO\ - �o\°vS \OO -C:3` C2I )\ I20(3 - (tEti nq -5611-9
\ CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
(,04DCbf? 110 kJ An \ — \ 3 - b1
APPLICANT OMPANY NAME APPLICANT NAME OFFICE PHONE
(-L c o'r(\-c �-t C. c` Cr C 601--.S o.`Tin cx ,s or. (tete-, ) (. a. -( c\
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
(‘tcb uc k,A,- mvAAA B-O l.koA,v»,\co, vALA 80?-2 (Za,) Q1Za- c2/32-3
RELATIONSHIP TO PROJECT FAX NUMBER � t
❑ Architect ❑ Tenant Agent ❑ Other (L(j ) B2-q-- Tf'1-4(-4
PROJECT NAME �� �1,, ' PRIMARY PHONE E-MAIL ADDRESS
CONTACT , ,.. - \Y (,, ' (L (G) �4i.� - Lo9)U,\ ( V`anc.aiiC? C05(O-c e.ra'h
LENDER NAME N // Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS - CITY.STATE,ZIP PHONE
( ) -
J p • DETAILED BUILDING(INFORMATION .'`
EXISTING USE �PV (J�C1(U� ��.it la..l (�`e V Ore. 1 PROPOSED USE �A
Ts
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $" 1 00 6
SPRINKLERED BUILDING? .rirlrES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 010
WATER SERVICE PROVIDER ❑ LAKEHAVEN C HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
L • •
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT 2 �y 1
FIRST \ 19200 l\ , 2960 \ ?Do
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
EXISTING PROPOSED TOTAL TOTAL ERIS77NG SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**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(Commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Mb/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toilet)
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 applicati n. �
SIGNATURE: s� t� �'( DATE rG ' 1. 04-
Property Owner and/or Authorized Agent
FOR OFFICE USE ONLY
o NEW o ADDITION o ALTERATION U REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES ❑NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES - NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100—August 16,2007 Page 2 of 4 k\Handouts\Permit Application