07-102655 o
federal Way
®�� PERMIT SF MF CO ME EL PL DE E FP
COIt.' "AV DEVELOPMENT S0•
111111
i' 33325'8 AVENUE SOUTH• J�•t 8 ^OQ A P L I C AT I O N
FEDERAL WAY,WA 980• 18 (� TD
253.835-2607•FAX 253.835-2609 ` . / /
www.cituaffetisrnlwnu.cam 1 ,`wy}..t1r
411) The following is require 1. Q I-an incomplete appl cation will not be accepted. Please print legibly(in ink)or, type.
S PROPERTY INFORMATION
SITE ADDRESS '6\U5-1') V�,VI C1 .4 S I 0 UNIT# C
ASSESSOR'S TAX PARCEL# -
�� ic?, LOT:SIZE(sj)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal deapiptionl }n( + b 1
• '1 • ZVi :T 01 ¢s
TYPE OF.PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 'FIRE PREVENTION SYST::1,
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
G-Oa i -ei Dom— \tv;ke.vrr Wr 0‘1._bKs - 7-. 1 -
PROJECT NAME(Name of Business or Owner Last Name) (1(,.-'dZ2 .(..�',^—$L r y J TLPf,,4-&4t, .---- _
. . a.PEOPLE INFORMATION
PROPERTY NAM y' l , �- PRIMARY PHONE I
CM
OWNER !)(104,5 I, d ( ) -
MAILI G ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
• CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Vat
j� RES 1 re' �D(\,1�(, , 1 ( I)ta - 'rte
CELL P ONE
L71'YyFFED L WAY BUSINESS LICENSE U BER C ��� IRATIO DATE FAX NUMBER
COPY of e�rd rcgolrcd CONTRACTOR'S R GISTST, NU BER EXPIRATIO """D TE E-MAIL ADDRESS
w�lth each appLeatlon � � C
APPLICANT OMPANY NAME(\� ,� VVV`��-/ Illlll4 lV''1�T A ICANT NAME ` OFFICE PHONE
NG ADDRESS)�ra 1 of 61 t ten s, J�1TE,ZIP C�-out\r\Act (424p.i.- ( O - Cl
R LA IONS IP TO PROJECT I FAX NUMBS
0 Architect 0 Tenant 0 Agent 0 Other (? �� rJ 1.xFFT)
PROJECT PRIIM(A"RYYPHONEj' E-MAIL ADDRESS
'11\\A
CONTACT V J \ V 1 (3 } 4%).- a O/�o
LENDER NAME Per RCW 1927.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
■ -DETAILED BUILDING INFORMATION -
EXISTING USE e- / 4-I/ R e.„4-.a / PROPOSED USE l h.Si/ropt,e- e O4-'&i?.
EXISTING ASSESSED/APPRAISED VALUE $ 1) VALUE OF PROPOSED WORK $ f/WO
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE41111
0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑.PRIVATE(SEPTIC)
i • • •‘-4
#� 1, AREA DES ION„,.�,,... EXIST.m^ PROPOSED TOTAL
) 4 SQ. SQ.FT. SQ.FT.
BASEMENT
FIRST 1 4-00
Vi
vo
•ECOND / V t
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
-GARAGE 0 CARPORT 0 .
EXISTT0 PROPOSED TOTAL TOTAL EOBTTNO SP TOTAL PROPOSED SF ) TOTAL SF
NUMBER OF FLOORS l('yo o
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
.■ FIXTURES
. Indicate number of each type of fixture to be installed or relocated aspart of this project. Do not include existing fixtures to remain.
MECIIAMCAL
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 Tub/Shower Combo) LAVS(Bathroom sinks) URINALS MISC(Describe)
11!
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS WATER CLOSETS pose)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
• HOSE BIBBS SUMPS
SIGNATURE
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 part of
this application.
NAME/TITLE f DATE nI CA. 101
S at ) (Title)
RELATIONSHIP TO PROJECT 0 er Agent 0 Contractor 0 Architect 0 Other
= 1�*..` pkv -3.'�:' (3< ..� 0+Q>s
D NEW a ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT. .
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES a NO
ZONING DESIGNATION CHANGE OF USE? o YES o 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
• •
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Bulletin#100—January 1,2007 Page 2 of 4 k\Handouts\Permit Application .