07-104664 t r',I i LO kilf,€:_i_f4._. S •
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Federal Way n,u 2 3 2007 PERMIT
SF�MM CO ME EL PL DE EN FP
COMMUNITY DEVELOPMENT SERVICES �,. -
333258mAVENUESOUTH•POB 7,T�$OF FEDER:% 'l'' PLICATION _
FEDERAL WAY,WA 98063-
253-835-2607•FAX 253-835-2609 BUILDING D ��
uww.cilpollederalwatl.com E�fjDt CC
-
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS - • S SUITE/UNIT# PIA
ASSESSOR'S TAX/PARCEL# I 1 b I 5 0 - I LOT SIZE (sf I z) l5
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) in -fc,F .,tr*1(x I-111A,S, �/`II Lr1s�(i
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT y(BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onhi)
GOO S t" rt1 t ll'k OE IA*1 14` RA`,i (? -I- -c 1) G)(tTi.A-At t/---O 4.--.--1. e- , W
PROJECT NAME(Name of Business or Owner Last Name) �t Irf frt:.-tnl(I 1.--(((nc a_ S 1 C
A
• PEOPLE INFORMATION
PROPERTY NAME g PRIMARY PHONE
OWNER MOA(C V9c iDv L WIN-11 LP (4Z5)81)3 - '0030
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
40 i ' f- . PCP - J *30 KIP-KA,AND' WA, 1$0
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
M 0 i A Ii: J57iC FE) L- v(k1 L-P (q25)(60".3(607:3 - g')30
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
l'{0 I 17Ail-f 171-*CC If 711 t#LLlr;-i.AI I).. v/I' 160'3'3
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
ZO' 07-" ---I C'Z`)1`f -- tk% — L. i 21'3 i I L' - (q y5) - l-, - 60 3 i
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
COPY of para required
with each application I >.. Z..J �-------......
M,JSl�-iUlr�'>� JJ � l�
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
NWci (c.- JCI-•RlyvitAL \ "'LLl1 L-e Il4t2-- (ui3C; (11z-J)0O3 - e035
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
140 PAS f'ltt-IT, 3./I %JZ.-t-t-A GI WO, 4Q 33 (LfzBER I?, - 3T(S
RELATIONSHIP TO PROJEC'11'
0 Architect o Tenant o Agent 0 Other E'9t-°1i (tJZ5) .? - ' 193 1
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT CI`4 10\)54 (14 Z5)047 3- - 1001 kms-1044te eMOSA,(640As4,VC.CoM,
LENDER NAME�," Per RCW 19.27.095:
1 � rg IC4,JK Lender information is required If project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
3'7r S,,J e t` akt,l, v-in -4viz-v-` W(k et6 4 (`{Z5) 't`( - 07-31
IN DETAILED BUILDING INFORMATION
EXISTING USE 1-1-1c3k'4 cpcfrier PROPOSED USE 1I'--F1ki okie.A"@i c
EXISTING ASSESSED/APPRAISED VALUE$ NI I& VALUE OF PROPOSED WORK $ `T L 1000
SPRINKLERED BUILDING? 0 YES -9(,NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES .i NO
WATER SERVICE PROVIDER yl,LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER !.LAKEHAVEN 0 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(❑COVERED OR ❑UNCOVERED?)
GARAGE J$ CARPORT ❑ *q0 310
EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS i, __, ctrl 0 z f —
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
• FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work$ N N(A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
..`
AIR HANDLING UNITS EVARATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS %�� GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE IVSERTS HOODS(commercial)
COMPRESSORS FURNACES ��",�� RANGES
DUCTS GAS LOG Sb.15 " ' REFRIG.SYSTEMS
PLUMBING
BATHTUBS(orTub/Shower Combo) IAVS(BathroomSmks) URINALS MISC(Describe)
DISHWASHERS i2AINWATE'R SYST VACUUM BREAKERS
DRINKING FOUNTAINS _ SHOWERS WATER CLOSETS(Totter)
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 V►1'l 14fir DATE t-fr3/07- _
(Signa re) (Title)
RELATIONSHIP TO PROJECT 0 Owner ❑Agent o Contractor 0 Architect *Other EM?L4\1 _
FOR OFFICE USE ONLY
—
❑NEW ❑ADDITION ❑ALTERATION o REPAIR ❑TENANT IMPROVEMENT
—
BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? o YES 0 NO
ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? ❑YES ❑NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
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Bulletin#100–April 2,2007 Page 2 of 4 k\I-Iandouts\Permit Application