08-101466 alk CITY
OF ®,.. .� i 0 / `— 6 Federal vi yE PERMIT Cfag' _
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE E FP
3332F5E8DTMEAVENWULS WA 98063-97018 Aa 2 s 200APPLl CATI O N ID
253-835.2607*FAX 253-835-2609 / /
The fo[lot 1 7 Y ref ti[Prmctal--an incomplete application will not be accepted. Please print legibly(in ink)or
type.
III
III PROPERTY INFORMATION
SITE ADDRESS_J-2-O 2-0 J 2 A- SO 4'- ) F eck e r4( W cry SUITE/UNIT# ye
J
ASSESSOR'S TAX/PARCEL# 2 I 5 II 0 C) - O O 3 (') C LOT SIZE(sf)
K
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) TP Amerl C T/[m Ea57 1 a)1taus Te rr ed.,
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT ❑BUILDING ❑ PLUMBING 0 MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL 0 ENGINEERING %FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onl4)
SI1-\l'`4- Pk re. lSs-E-e4,s C SFS\ w,'I l 4 mo. �-�j -\-i 'ex(S-�n.} tv�e+ �; ee I re
r `CD"-cL :c,v- 5144eV.- �n Q CCt.w,r�noda-V e -S(1.�Q. Yve,.J I-V a 1 l 5 CAM Ct C e t 1t•nJc s
A-I l w usr k w ;11 fie, v t;{- N 1 Pfd- \3 a,Ad iii-e. c 41 U4' Frer4/ W 4y .
PROJECT NAME(Name of Business or Owner Last Name) KT P A me c i c c.. TI e 1=c 5+ C c t A e?u S I e r I''4 c(✓
IN PEOPLE INFORMATION
PROPERTY MAME 1 PRIMARY PHONE
OWNER }JON\ct Nvn't O ertlop men.T (&n&f any L LC (2o(0 ) 21/' - o 5SS
MAILING ADDRESS ll 4 ,4 CITY,STATE,ZIP E-MAIL ADDRESS
t(74 0 0 $oa-Nnnc eu-1 '- i�tzr Kway 5oZ Stmcc'tftt,, W A- 9S 1 gcs'
CONTRACTOR COMPA ,NAME APPLICANT NAME OFFICE PHONE
SI�•*t..A ;re.. 5.3 sAs'e44ns,T,,,,,‹. C r&ly c.\ne.s1;k (2_53 ) ?'26 - /£sFso
MAILING ADDRESS CITY,STATE.
ZIP CELL PHONE
I/O to 5 I / „ E c,s� Tcc,w,—
, t,-.)4-- ti v/2 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
\`I — g7 - 0ooca55—o0 6L )2131/08' ( )
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
St1=t\.\t-S\36oT 11/2108
APPLICANT COMP NAME APPLICANT'NAME OFFICE PHONE
21-r“ . F'.�-e._ Sys--erou.S,-vtc - C t v`dy C.\n_esl,`K ('2 53 ) 9.26 - /f'ko
MAILING ADDRESS A q 1� CITY,STATE.ZIP CELL PHONE
1
\) O(9 5 -Nre-- zs'1` "fCt cWVLo/ W 4 CI ./2.,y/ ( ) -
RELATIONSHIP TO PROJECT j FAX NUMBER
❑Architect ❑Tenant ❑Agent Other Fdvi`r)!Oy eL (2-53 ) %,26o - Z350
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT \W.-fNe1,J Nr� Ier (253 ) 2-`1S -2-(1,72-. Inn,.;ller e.Sn,;-Fi-ere.,ca
LENDER NAME Per RCW 19.27.095:
Lender information Is required if project value exceeds$5,000
MAILING ADDRESS CITY.STATE,ZIP PHONE -
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE C 0 YY11'Y1e('c i et I PROPOSED USE (c) Y"I'\^erc 4 ,f
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ t)9 0 7
SPRINKLERED BUILDING? 0(YES O NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? RYES ❑ NO
WATER SERVICE PROVIDER p(LAKEHAVEN ❑HIGHLINE O TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
•
•
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 ❑
EXDTfINO PROPOSED TOTAL TOTAL ERSTIAO 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(commerdaI(
COMPRESSORS FURNACES RANGES
DUClb GAS LOG SI:n REFRIG.SYSTEMS
PLUMBING
BATHTUBS(ormb/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS frwko
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�ofthis 1application. l �j
SIGNATURE: �VU1.C9j e \JAI DATE ✓ 2 Co—6 -
Property Owner and/or Authorized Agent
FoR 0041013oStom,it,
o NEW o ADDITION a ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES a NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100-January 1,2008 Page 2 of 4 k\Handoutaermit Application