04-105219 ACEIVED
33530 FIRSTWAEV ELOPE•POS OX 9718
CITY of
FEDERAL WAY,WA 98063-971S
Federal- 8 2004 PERMIT APPLICATION 253-661-4115.soO � '�"'�9
Pet�D1La EUE AL WAY To:
BUILDING ' iteNumber': c,f - / 2-- J 1 - 0 d / /
The ollowin is re uired i ormation—an incom lete a lication will not be acce ted. Please rint le ibl (in ink)or e.
SITE ADDRESS: )2001 e&'pa a e" – ! SUITE/APT#
ASSESSOR'S TAX/PARCEL#: I 6, 2- 1 CJ 4 - 0( 0 C' I SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTION(e.g.:Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT(This application): ❑BUILDING ❑PLUMBING ❑MECHANICAL ❑DEMOLITION
❑ELECTRICAL ❑ENGINEERING EIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only):
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PROJECT NAME(Name of Business/Owner Last Name): 'IGCJ/rl�
• PEOPLE INFORMATION
PROPERTY NAME: .._ PRIMARY PHONE:
OWNER: FG ■ - - V E /ELOr ( )T.-6Z_-Ireir,
■ (( ���K-I iG�II LESS;):
�� C STATE,ZIP
IP 1` A 1 (c"1
CONTRACTOR: N 1E,sL '� ��� f� OF ICE PH NE:
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(C U 0-arc, , 'IN ADDRESS( ET ADDRESS;): , aZJP CELL PHONE:
�Q so 0 / CITY GOF FEDERAL WAY BUSINESS LICENSE NUMBER: EXPIRATION DATE: FAX NUMBER:
\\\ 1 _ ( -O b D 001- el
31 / 04 ( ) -
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CONTRACTOR'S REGISTRATION NUMBER: l A y p D EXPIRATION DATE:
(copy of card required with each application) ti 1) V A 0 FP 1 1 D s/ I /c
LENDER: NAME: DAYTIME PHONE:
(If Proposed Value>$5,000) ( ) -
MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP
APPLICANT: NAME: I COMPANY OFFICE PHONE:
. Ja14so#.✓ A 0114 A-LC-.- (92f)y83 -565 7
MAILING ADDRESS(STREET ADDRESS): CITY,STATE,ZIP EVENING PHONE:
( ) -
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑Architect ❑Tenant ❑Other(Describe): ( ) -
CONTACT PERSON FOR THIS PROJECT: ❑Property Owner iii&Ontractor ❑Applicant E-MAIL ADDRESS:
• DETAILED BUILDING INFORMATION
EXISTING USE: PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $
SPRINKLERED BUILDING? MMES ❑NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: ❑YES ❑NO
WATER SERVICE PROVIDER: ❑IAKEHAVEN ❑HIGHLINE
0 TACOMA ❑PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑LAKEHAVEN ❑HIGHLINE ❑PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING SQ.FT. _ PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OF 004
ADDITIONAL FLOORS(DESCRIBE) r-t.oz
DECK(COVERED?) O TRAY
GARAGE/CARPORT
HOW MANY FLOORS? TOTALnaSDNG TOTAL PROPOSED rv=ALEXISTINGANDPROPOSED
**NEW HOMES ONLY** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• FIXTURES
Indicate number of each type of fixture that is to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(Commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS(Toilet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYS
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sink VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCI,AItiIEK/SIGN.ATURF,III 0(I.
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 information supplied to the city as a part of this application.
NAME/TITLE: IBC-�� "� /-44- d7 DATE: 12-22 eael
(Si ature) (Title)
RELATIONSHIP TO PROJECT: ❑Property Owner eApplicant [Contractor ❑Architect ❑
folkO SSE ONLY:
❑NEW ❑ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES n NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION: CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? ❑YES ❑'NO UP/SEPA/SU? ❑YES a NO
FLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100—January 13,2004 Page 2 of 4 k:\Handouts—Revised\Permit Application