06-103850 . RECEIV• ill
CITY OF •uV. 0 4 �OO{J L- _4 3 / 0
Federal Way
+�� PERMIT
COMMUNITY DEVELOPMENT sr l✓Tc'1!'sOF FEDERA SF MF CO ME EL PL DE EN F
33325 8TH AVENUE SOUTH•PO BOXi� ''"h�'p LI CATI ON __
FEDERAL WAY,WA 980639718vILDING DE
253-835-2607•FAX 253-835-2609
www.c06offederaiwau.com
The ollowing is required i ormation-an incom•lete a,plication will not be acce'ted. Please •rint le,ibi (in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS 3 2 2)ZL.5 ,. 3 SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 1 5 14 6 I- O Q 3 Q 1 LOT SIZE(4) ?).1
l( (LC--
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) L0+ C ec...SA ec....--.. 'n.S Co.O o J J Pct.-k P�v c..L i
(Attach separate...a for I Iengthy {',d cAption) f
2LwvdJ Vo . di 1
. PIc. R - x
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING )S'FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description� of work includednon this permit onto) (� 1-, �1 1L
UL... P.►� ryuw kale L.-Vs A�^.�,.vM. i.7N`vrk TO �,li• % CC.- 6k.�C, g At0 �-i 6
t-04-c)1 , �- 6,,;L 11. $ FIX 's..
PROJECT NAME(Name of Business or Owner Last Name) E,„„.'\ l c.,.....A,A.S--t?r.e,..CA
• PEOPLE INFORMATION
PROPERTY NAME 11 1� 1 PRIMARY PHONE
OWNER r4�ne, 1C�v,. kJevclop IJ1qt.� C(�c,�- ( ) 247 -bac
MAILING ADDRESS Cm*STATE,rZIP
it (OO „,:e,.,I., Pa,_ki . -{Q 91(v$
SS$$e 5b3 i
CONTRACTOR COMPANY NAME d APPL ANT NAME OFFICE PHONE
^ .bt-- ,--> Ale . �117t-�v s (.4-t-f)es), ... ( ) _
MAILING ADDRESS CITY STA?...ZIP CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER -
/ / ( )
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
/ /
APPLICANT COMPANY NAME n --1;,."..,-
MAILING
NAME i` ..�� 00 OFFICE PHONE
ArG.lA2 v C.7".,C.,A-4'L.A.c.1lor \Tv,� DWInK!��JP- r (2c3 ) $7.Z -
MAILING ADDRESS CITY,STA'It ZIP e CELL PHONE
7 C S. a06Ai c$. k 4 Wo\ 9703a. (x6 ) 57( - St o3
RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect 0 Tenant 0 Agent ❑ Other(Describe)5.A.[)c.,-1--......c4,..,— ( 3 ) 10.a. --/X77
CONTACT NAME- PRIMARY PHONE E-MAIL ADDRESS
..T( �Ar-,L(G 0-5-3 ) g 71- ?0-D-D-
LENDER , ra . �xrr� NAME w�) t ' "seds.. ,may-, l ash , = $6000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION ryry+
EXISTING USE PROPOSED USE ert-('PD SP„.cy.
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ lieoo
SPRINKLERED BUILDING? 4 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? X YES 0 NO
WATER SERVICE PROVIDER )iI LAKEHAVEN 0 HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER jlT LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
•
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 ❑ CARPORT❑
EXISTING PROPOSED TOTAL PROPOSEDSP j ToTALSP
NUMBER OF FLOORS w`
**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 $
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 part of
.this application. (�
NAME/T �t� A 4 I°�J,t7� [nu
p J �� DATE OQ
I6t�D°i?
(Sit ature (
RELATIONSHIP TO PR• T o Owner 0 Agent ❑ Contractor ❑Architect ❑ Other 10
FOR OF', " .. : Y
o NEW s a ADDITION w,vi.• „:,%.../ts a a, ' 4•
� � � f° Pte. 1,� � S s � �;E '
•
BUILDING SHED,ONLY? a YES re NO %> a,o�.:(
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Bulletin#100—January 1,2006 Page 2 of 4 k\Handouts\Permit Application