06-105434 ,' RECEIV D
41
OCT 2 t 2006 4
Federal WaYITY OF FEDERAL WM PERMIT iCOMMUNITY DEVELOPMENTSERVIcU1W(NG DEPT. SF MF CO ME EL PL DE EN-FP
33325E E FEDERAL
A SOUTH 98063 BOX 9718 AP P L I CATI O N
io 5 k r _6
FEDERAL WAY. er 980Lcom 8 .
253-835-2607•FAX 253-835-2609wimpip
ww w.cityoffederalwaq.com
The ollowtn. is •uired i ormation-an incom•tete a••lication will not be acre. -•. Please •rint le,ibl (in ink)or j, .
- • ,PPROPERTY INFORMATION
SITE ADDRESS „ '' 9 3c)-41�' 7IN )S J" S A064 / SUITE/UNIT#
t
ASSESSOR'S TAX/PARCEL# ? j S -! Q �'- 0 O LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page,(lengthy legal descnptton)
MI PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING 0 MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed descrtptLonpftworf included on this permit only)
Fi Y'E (-1 LA(2M 1-0Thv /
Li
PROJECT NAME(Name of Business or Owner Last Name) (z-7S r CAM frU S Of-TF(Lam' P("T AR K
IN PEOPLE INFORMATION
PROPERTY NAME S C :g. , ' n /� )PHONE
OWNER • J ��'t/Y -
MAIL.1 ADDRESS 4_54(
.�+Q ,60 STATE ZIP /'�/ ^„ �/
CONTRACTOR COMPANY NAME k/APPLICANT NAME OFFICE PHONE
Au-mil-Perk,u Corte Vm . cop ' M (-lit
i e() (( 5�3 `iolco: ti`f 7
PHONEMAILING ADDRESS
cjt) 7 (9 -1J77 FI FLi WA ,0-"( 7✓7 7- C.-MA--
CITY
ERAL WAY BUSINESS LI NUMBER EXPIRATION DATE FAX
UMBER
7o-� -i .0 ' z `L-B L t? / 31 /v (Z53 ) (o -( rj�
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
0I.: i C ElLC, L (c LX111 c C) I /.31 /67
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
A - Ta r'- i- 1D COnI m, c.,.;r p t44Ss e-e. P1/4_C.--t e t t (2,53 ) 901(0- 19Lt-7
MAILING ADDRESS (� y- �, CITY,STATE,ZIP cy��') CELL PHONE -'7^-�
RELATIONSHIP P t 4:TO i C" 1 ILJ�1 C.'i �.7j itk. 7 /�1yy L F( i `,A]A U IC. .' Fd63)NUMBERAX 3 C [ - 67 b,
❑Architect ❑Tenant 0 Agent ,Q'Other(Describe) Clim- to (.'1Z_f2 (LS3) 9a(. 199(,
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
155)C ,'', tIf tR ( ) -
LENDER Per RCW'19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY.STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE _ 0 ' ( (
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ Z') 0(( )
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE a PRIVATE(SEPTIC)
•
....._.
, • ... dil
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❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
"*NEW HOMES ONLY"* NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
�..._._ __.. .w.. ._._._............ .....�...._._ _._...... ...._..._m..._._.....ILLI_...„..__...___._....,_.... ... _................_..�..._........__._....,._,._.�_..__._.
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(commereial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSL IJ Follett 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/TITLE; /(1/004....
' 1 DATE I 6-a L1' ` [jt )
f V'�r�'”" (Signatufe) (7]tle)
RELATIONSHIP TO PROJECT D Owner ❑Agent N0,Contractor ❑Architect o Other
FOR OFFICE USE ONLY
❑NEW c ADDITION o ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? o YES c NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? c YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100-January 1,2006 Page 2 of 4 k\Handouts\Permit Application