05-105910 a •
Ecovtit)
CITY OF / 0 ( \
D��
Federal Way NOV 16 2005 PERMIT �� Fp �
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE �,`v
33325 8TH AVENUE SOUTH•PO BOX 9718 ����,. TD
FEDERAL WAY,WA 53-8 3-97 ,-�9U L I C A T I O N �—�
FEDERAL
07.WAY,W 253-835-2 )L t e �I+ t
urwwe*yatf,deralwau.cam
The ollowin• is re•uired in ormation-an incom•lete a.•lication will not be acce•ted. Please •rint le•ibl in in or •e.
PROPERTYIN 3 _ INFORMATION /
SITE ADDRESS �'415 1 S� w01 c J`-V1 SUITE/UNIT# `
ASSESSOR'S TAX/PARCEL# - l LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) Pay UC h1 V u i O P2kiI(A. im(J ~ wax
(A ach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT D BUILDING ❑ PLUMBING 0 MECHANICAL
0 DEMOLITION 1 eAIr t ENGINEERI �� 14i,/ ' PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of wor included on this permit only)
!Vigil(11( S111,bK- 6U+f C v rS, 5 110 VII f St-I'otx( / 1 S•tM)7(•
PROJECT NAME(Name of Business or Owner Last Name) Mai(2W 0 6-4 O It f I qr-fiV`x
• PEOPLE INFORMATION J
PROPERTY NAME PRIMARY
'^.��nn��,�y �y �j, 1 PRIMARY PHONE
OWNER Nt131rtstAn 0#k� bd(1AIi11- {n1�F p-019 )G3. - 2-16T)
MAILING ADDRESS ITY,STATE,ZIP
3 3415 t Sk W el SU Ili --eaa rae Kiy i VO- '1 gcn
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
yN0Chlo n fcarn') MC Vat i-€ iO (2�c '3 - 32438r
MAILING ADDRE / CITY,STA ,ZIP CELL PHONE
\ 7) s 7a k s-r Sea ,W A ani 44 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
- - - B L / / (-AD ) 322 - '1"1-111-
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application( EXPIRATION DATE
WI &- S al hI ? EL C- 3 / /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
VNI 0,01 (vwro M.aVnr, 112(, vi 1-t j-•e( of (��) 32 �2W.
MAILING ADDR S CITY,STATE, ZIP J CELL PHONE
)253 S -Ta ctVi ST Sfif) Iii fc ei &1'. ( ) -
RELATIONSHIP TO PROJECT �n -�,,� FAX NUMBER
0 Architect 0 Tenant 0 Agent Other(Describe) CPY I ft_U Y (tab ) 322, -—72,0 f"
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
t lktV -eli011 c? ) '21 2y-a-is
LENDERPerRCW 19.27.095; Lender information is NAME
required if project Value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
■ DETAILED BUILDING INFORMATION
EXISTING USE 9 PROPOSED USE
( I�,
EXISTING ASSESSED/APPRAISED VALUE $ if I I 0' I1 VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER a LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
• •
a
♦ PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS DG PROPOSED TOTAL TOTAL87°SintasF OTAGPxoro�DBD TOTALSr
**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 $
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 SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(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 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 the information supplied to the city as a pa
of
this application. A/� `'
NAME/TITLE (kA -fktu�� DATE l / 14'i 0�
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent )(Contractor 0 Architect 0 Other
„cm,nssrian,ugRAdti4Y1Adaq,,vuoalo-0,,
oINEW a ADDITION ❑ALTERATION REP AIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES'o NO BASIC FLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? a YES o NO
FLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? o YES' o NO
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application