06-100370 • III
�,T� RESUBMITTED 0 .4 - 1 e_o_.33"
�e��r�� a�` PERMIT
COMMUNTIYDEVELOPMENTSERVICES SF MF CO ME EL PL DE E FP
33325
FEDERAL UE SOUTH•PO BOX 9718 JAN 2 5 CATION
FEDERAL WAY,WA 98063-9778 ��/ /
253-835-2607•FAX 253-835-2609 -_„7/�
:<'a:;"'.” :::'_,<""'="-<;CITY OF FEDERAL
The ollowin• is >•ui , � i!Ibi?E�etTiitcom•lete a,•lication will not be acre• ,- . Please • t let •I. in or ..j. .
• PROPERTY INFORMATION
SITE ADDRESS 7.255 3, 32Zs l `EDcJ AL hl4 f WA, CI ge.Z.3 SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# _ - _ _ LOT SIZE(sJ)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
!Attach separate page for lengthy legal descrq#bN
■ PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING fil FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onitl)
INVTA1 i 4T 1i e 41fi;_r r R.ia2 i* KeTax•6.4./ 3YSIfirfi Th. UL ;anrAk.D5
/Mood
PROJECT NAME(Name of Business or Owner Last Name) t?))N
I. PEOPLE INFORMATION
PROPERTY ' NAME PRIMARY PHONE
OWNER 7 hl` !N ('Z55 )C1 -13(d-tie
MAILING A DRESS CITY,STATE,ZIP
.a 2b 5 62.,trii Si TEDERALVIAyr \AA, `Ii6�3
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
TI RE. CA rec u►Piv1 i 1i, GRfl:> L11i.iunlS ( 445 )6,41 -a1.2.7
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
t);-`m Viol r r_r+0 )%aft, Ggc.-- (4a5 ) 4i45 - 4/5
C OF FED WAY BUSINESS LICENSE NUMBER • EXPIRATION DATE FAX NUMBER
/ / ( )
B L
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
1 I E. G L' I.- ,. 0 e 1 q es Lt / G1 /a4;
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
Ti C-i414 E. ii?"'rcbi, C.c;, C= c. VI iLk.i hi5 ('ia5 ) toLl1 -2/.z-7
MAILING ADDRESS LLl!..,, CITY,STATE.ZIIP� WA Gf p ^�Z CELL PHONE
RELATIONSHIP bt5TO PROJECT 4 45C-1 REDM6NVf , 1 Pt/ 7 (`1.5 ) 195 i-r 75-r
FAX NUMBER
❑Architect ❑ Tenant X Agent ❑ Other(Describe) ( ) -
CONTACT N PRIMARY PHONE E-MAIL ADDRESS
\41ucrniS (4k?)tiLih - L ,'2j i
LENDER *144RCW.192?09.5 LendeeLnfotrsittton NAME
titgttraed_ 'ptnJeet value 0ds$5,000
MAILING ADDRESS CITY,STATE.ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REgUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER d LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
• •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
Sg.FT. SQ. FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL .::'::'5ar+►t;. ar ' 1O ALPROPOHP9M TOTALSP
**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 $ LI?tot.•CTi�
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS vZ HOODS(com,nc,ziaa WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(oerub/showcrCombo) SHOWERS WATER CLOSETS(Toilet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAYS(Bathroom Sinks) 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 to 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. /�r l
NAME/TITLE V y�,L C6 I QAL%6R DATE ht 41/ ,
(Signature) (Title)
RELATIONSHIP TO OJECT ❑ Owner A Agent ❑ Contractor ❑ Architect ❑ Other
........................................................................
........................................................................
........................................................................
to N�iVI...> ti.ADDI(T;DN a ALTERATION ❑REPAIR T NA
SIIILDIN( $I Ltt;1 NLY? a <r NO BASIC FLAN? n YES a NO•
ZQNIR'IG DESIG:11I 4TION CILANDE tail USE?':> #YE$ a NO
ADDRESS:REQUIRED? •••a TES
PLATTED LOT? a YES `a Yt� ; DEMO PERMIT
osNO
Bulletin#100—January 1,2006 Page 2 of 4 k\Handouts\Permit Application