08-100430 � IRE ED - v
civ . 3
COMMUNITY DEVELOPMENT SBRVICES JAN" "II
2008 PERMIT SF MF CO ME EL PL DE Els '
33325 a AVENUE SOWN• O BOX 3.9718 18 ��, C AT I O N
FBOBRAL WAY,WA 98063.9718 --QQ�
'153-835-'1607•FAX 25 �a Qf� C
FEDC - TD _
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The following is required in,ocmation-an incomplete application will not be accepted. Please print legibly(in ink)or type.
t(• PROPERTY� / INFORMATION
SITE ADDRESS 62015 - 2 3 ✓ Vryryi�c . S -
OU h SUITE/UNIT# A
ASSESSOR'S TAX/PARCEL# 2 2 `-D O
- 0 ( C) LOT SIZE(sf
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
eft.*asparate pegsfor lengthy legal description)
IN PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING V FIRE PREVENTION SYSTEM
PROJECT 'ESCRIPTION(Provide,detailed descrip•'.n of work included on this •ermi o ,
NA - 0 III & . 0._. - e..a •' 1 _I. . f'•
bU I - FIT), ►
PROJECT NAME(Name of Business or Owner Last Name) .f 1'`Yte-Lala ivtocicasri R"e.<�ieukrayd--
• PEOPLE INFFORMATION
PROPERTY OWNER NAME �-t / v� � ' 1 /PRIMARY PHONE -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
%(^/ )DDRESS
CONTRACTOR COMPA7 NAME APWCAlft NA Aka 11C O CBfON$
lll
MAILII�QADDDRE •74
L .i-y TE,r45 �
A_ 9CCOELL P nNt% - iLL , '
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER L_I�J
iCI 'gz-Oa0o20
2--O -6 1431I) (253) 0.36 -4-8'51
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
aASCA A-1, 109)-3-7- vital oB 1(cArleeccaorkaktoyaoi
APPLICANT CO PANY NAME AP
/�-1 Gc,�rvi L (. C ( �1CANT iM OFFICE PHONE
Xo�o 1� (2a�mil -ZD
W O ADm. -1469
STA E,ZIP CELL P ONE
2
TIONSHIP TO PROJECT ,',� i,G, FAX NUMBER
CI Architect Tenant ❑Agent Other CDI1frGlo r (203 bat) - 51
PROJECTCONTACT NAME ('E { c, soss
(�PRIM �H j��� - 1,. E-MAIL ADDRESS
LENDER NA : `_�J-'�p�,/J Per RCW 199..27.095: v11
Lender information is required if protect value exceeds$5,000
MAI 1 0 )0 RESS CITY,STATE,ZIPPHONE
_-mi
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE ``__
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 'x,O
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS EXISTaO PROPOSED TOTAL TOTAL EXASf NO sr TOTAL PROPOSED SF TOTAL SF
**NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
II 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$ 1500 — (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(commatdas
COMPRESSORS FURNACES RANGES
DUCTS. GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shover Combo) LAVS(Bathroom Sims) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS crow)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify under penalty of perjury that I am the property owner or authorised agent of the property owner.I certify that to the best of my
knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with all applicable
City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the issuance of this permit
does not remove the owner's responsibility for compliance with local,state,or federal laws regulating construction or environmental laws.
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, but only
where such claim arises�;t 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 t plication.
—2-9-45-1
Properly
DATE '
Properly Owner and/or Authorized Agent
a NEW a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? o YES a NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application