07-106109 r 1 .
airy OF m""- wa -IRYY E'�, C, / 1 D I O
Federal Way PERMIT l YYY
COMMUNITY DEVELOPMENT SERVICES NOV U 7 2007 SF MF CO ME EL PL DE EN/ P
33325 8T"AVENUE SOUTH•PO BOX 9718
FEDERAL WAY,WA 98063-9718 Ai�PPLICATION / /
253-835-2607*FAX 253-835-2609 1�
u u'u, ugoQ'derahr01J eom CITY OF FEDI
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
3 4
2,I /1111 PROPERTY INFORMATION /
SITE ADDRESS 5i 5 ' t-f(.\ f J�- • S O Lk.* L\ SUITE/UNIT# I (PCU(
ASSESSOR'S TAX/PARCEL# 1 5 C) S /
I - U`� 2- 63 LOT SIZE(sf
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page ibr lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT E BUILDING E PLUMBING E MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING `QI FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
pi r'e ALC v'vv-k, '2 . Gti",, f--` 'i.vS r ovx tU 0.C.r_ov,cockk clach k7i Cy-t OF (Li-t-( PC i
D-ep -,U vtfi vZMht r`t- t.-j 42 i w..,0 .Vih vi v,-A/‘... k_ CA- C. --y1,--‘6 CC/1z vA
1,, c,f-v c, •
PROJECT NAME(Name of Business or Owner Last Name) 5 • f- alr1 C-i.r_`: 1 Cx-),"], t cis.,/PC t MC t Li-/Yr,
• PEOPLE INFORMATION
PROPERTY NAMEPRIMARY PHONE
OWNER I✓ck.v1(ri C.0,/t/) r ✓\ 6 j6.1-e-({\ ( ) -
MAILING ADDRESS ,J CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
MAPF-tom F1(,EL,1121(, 4ee,1,9LAL1.- (2.617) "3122 - 4S4-17
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
Yt 31 c . 5 VaAty . -1--at.cc,., .._ W A cc( ( ) 4tet -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
tel-fldi_ 16)(4_74-23 -CD -Bi (-07 (1.-f=7�) tl -1D-i11
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
'-4A , - \t-} 0P/ 2)U' L>q
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
''‘mp1e)CC- rinaCl { ik OR_2a.v' (24L, ) 1.1t - 14-00
MAILING ADDRESS WY,STATE,ZIP CSbb PHONE D t,2.
(45 i•Cl 044'` Avv • S 4 1 U U eci.f--f.e, 1AJA and lag ( Zoc„) lq( - 11-1-00$
RELATIONSHIP TO PROJECT �,� FAX NUMBER
0 Architect 0 Tenant ❑Agent Other Si`-k' Std(-C?hl „,rit.,\/' ( may) 'i I - i 50
PROJECT �) ��^^� PRIMARY PHONE E-MAIL ADDRESS
CONTACT Gl '1 V Re ,( ( '� U I - (4 Lpq Kore ares ty CO 1,1f.CZ>n
LENDER NAME Per RCW 19.27.095:
0 A Lender information is required if project value exceeds$5,000
MAILING ADDRESS ” CITY,STATE.ZIP PHONE
( ) -
■ DETAILED BUILDING INFORMATION
EXISTING USE K-3C) ) " C;y trr,.�C CVN PROPOSED USE (C-l I pe-Lk. 0-e-pOth-t-
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ Q Lp, ()8 U V
SPRINKLERED BUILDING? (YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN o HIGHLINE ❑ PRIVATE(SEPTIC)
• I t
• 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 ❑ CARPORT ❑
EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**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 incll'th'existing fixtures to remain.
MECHANICAL
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATIOIM
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
_ BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS)Commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS for Tub/Shower Combo) LAYS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toilet)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify under penalty of perjury that I am the property owner or authorized 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 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.
SIGNATURE;-'1"-,C.--i 1.4 . r,`cul-, 7J,(\J,'m.i;,L :Kc;_ 7)., oL,Y1.. .k ( DATE i r. ' >Q 'L
Prop rty Owner and/or Authorized Agent
FOR OFFICE USE ONLY
NEW L ADDITION ALTERATION I REPAIR TENANT IMPROVEMENT
BUILDING SHELL ONLY? YES NO BASIC PLAN? I YES Li NO
ZONING DESIGNATION CHANGE OF USE? YES NO
NEW ADDRESS REQUIRED? YES NO UP/SEPA/SU? YES NO
PLATTED LOT? YES NO DEMO PERMIT REQUIRED? YES - NO
Bulletin#100—August 16,2007 Page 2 of 4 k\Handouts\Permit Application
�I'30['.21`(r7