04-103483 ctrr of 4A (.. `�
Federal Way 4UG 2004 - 4 '
004 PERMIT SF MF CO ME EL PL DE Eo' FP
COMMUNITY DEVELOPMENT SERVICES /�
33530 FIRST WAY SOUTH•PO BOX 9718 c P p L I C A T I®N TD
253-66
FEDERAL]-41WAY15•,FAX253-661 WA 98063-4]97129 ANG DR 1tLO EG DR it / /
P
www.cityoffederalwall.con,
The ollowin• is re•uired in ormation-an inco •lete a••lication will not be acce•ted. Please •rint le.ibl (in ink)or .e.
• PROPERTY INFORMATION
SITE ADDRESS -2i_71C `-`—T PLAZA% SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates, Lot 1)
(Attach separate page for lengthy legal descnption)
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING )FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide"(" detailed description of work included on this permit onh)) /1
tAllctt- 01\-�CCIt1�' firA 4:12" A_1. O.i-- CYC t l_C-=t C.,t1C 'f.4-C. - rifle
50M-f.. z 1 ( ,mac-as.tilt, (-cc-t cit-43 ten ; U acin 5 ,L)0 _c
PROJECT NAME(Name of Business or Owner Last Name) (
kVA a. ( J £-t
• PEOPLE INFORMATION
PROPERTY NAME
PRIMARY PHONE
OWNER VVV���"`efJt e 1c
-3'-(OZ)
NG ADDRE CITY,STATE,ZIP
CONTRACTORPANY NAME APPLICANT NAME OFFICE PHONE
rM(it&C-�( i€f C— kPM.x , - 4 ofZ& ( /2- 6(1 - 2 i�'7
MAILING ADD ESS ITY,STATE,ZIP CELL PHONE
b� 6e-ft-� -3, C �S 1 t: 1 ` VO-T3 ( - 3( 7
CITY OF FEDERAL AY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
tok.ES• l `l- 11-J .8 / _0 9 . = B L (z_ i3I / ot- (tt2S ) 562, - 646
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application)' EXPIRATION DATE
�- 1 (L �.,i2, 00 ' / 6`1 / 43
•
APPLICANT ,Q,MPANY NAME LICANT NA OFFICE PHONE
F--(12-k" cru-? etitcq- b y S (L( ) Gq( -2_ z 7
1�-ILC A.Fj� / �`'1 C Y�,STAA'TpE ZIP liio (`'{�ey CELL PHONE
RELATIONSHIP TO PROJECT (i'"_�� '�•�I1 V7 (y ) gI� - s1-37
FAX NUMBER
0 Architect ❑ Tenant 0 Agent It Other (Describe) (( ,1-tt . ,, ('('2 )5'62.._ _ 6,66 2_
CONTACT NAME \, �j43 \ PRIMARY PH N
J C�)p E-MAIL ADDRESS
�E (Lac) - 3 k• 7 "70tt,1030 /ail—Citi 4.Ccs
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ Q Ala
SPRINKLERED BUILDING? a YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ,pa YES ❑ NO
WATER SERVICE PROVIDER a LAKEHAVEN 0 HIGHLINE a TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
11110
•
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 EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
**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) W OODSTOVES
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 '•eluding costs, expenses, and attorneys'fees incurred in the investigation and defense of
such claim), w ' be ma•- • ••. •erson,inc g the undersigned, and filed against the City of Federal Way,but only where such claim
arises out of e relianc of t - city, inc :'ng its o rs and employees, upon the accuracy of the information supplied to the city as a part of
this applicatio
lirlir
NAME/TITLE ` DATE 4/67(A-- 2.0a&t./
Ignature) 1 (Title)
RELATIONSHIP TO P OJECT 0 Own 0 Agent A Contractor ❑ Architect o Other
FOR OFFICE"ISE ONLY.
o NEW o ADDITION o ALTERATION o REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? 0 YES ❑NO
NEW ADDRESS REQUIRED? o YES a NO UP/SEPA/SU? ❑'YES ❑NO
PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? ❑'YES o NO
Bulletin#100—March 30,2004 Page 2 of 4 k\Handouts—Revised\Permit Application