07-104573 AL
•t to r
117.-- 1 oaf 7_3
raaaermway RECEIVED
PERMIT
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE E FP
33325 ESOUTH.�II7X9719 .17 2f APPLICATION TD / :.��
FEDERAL
RAL WAA Y,WA 98063-9718
253-835-2607•FAX 253-835.2609
www.dhrolfedemltgay,pnY OP FEDEHAL WAY ��'
The following is regWi u,jt,P1 R On-an incomplete application will not be accepted. Please print legibly(in ink)or type.
/
-. PROPERTY INFORMATION
SITE ADDRESS_341 515 ' 1 Ave. SavTE 4 1 t' CiZ/se.. W 4cr , WA- SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) SEE. Arm c.4 ct%
(Attach separate page for lengthy legal description)
IN PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL s
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING Q'FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) v "
Re.-Rart e, exi S-T.v‘b. Rre_ L.e' cove-v.41-6i{ L y' 1 s'r craw. Jquez "Co 'gta i s-m,lrvx Fav--
Cu' it.tee GK t 1-'-�.eC 'Lt L C CJ-l(i w. . F•wl g/E v 'FOG. L CW$62_ -c(;) Gr Yb I..rr .F.
ficc_ Ctforrrnewt M k.-vp. 4 REwaoitE PLY 'CAMs .G[csoz to 110tserr:w6.
PROJECT NAME(Name of Business or Owner Last Name) • Fi W C.'S A03(21-teat-- C.-en-trot- 'f €C9 %3 c^rl•
U PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER Ra-exLsc,n,n �€ z- 3'trrt -ren (253 ) 4Z.co -6$3S
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
1711 5 -rA 3 3'reecT -T7 C ry.A , kiAr 18,446.5
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
tpcErei .SEEraErt Ceevoep-bail gay 3'ar+ES (44ZS )7.13 - 2756
MAILING ADDRESS CITY,gal.
ZIP CELL PHONE •
2'1I a Nr-ryc Mgc,.ti AS g , Lake-SteveMS 1 144 88258 (Ze6 )344 - 341"1
CITY OF FEDERAL WAY BiliT
SS LINSE NUMBER ��}// EXPIRATION DATE FAX NUMBER
(� b D7 —l V 7' (24(0 X8'1 - 53ect
CON CTOR'S RE I6 TION NUMBER EXPIRATION D TE E-MAIL ADDRESS
/ 3P 0'6 E S ip d�11 �/� 3�Oc- ruooaeM�3e..� e.te`,
APPLICANT OMPANY NAME APPLICANT NAME OFFICE PHONE
My err, 4-4t..."L Cerpwa-i•anS41ne_s (42S ) 143 - 27 S(
MAILING ADDRESS CRATE,ZIP CELL PHONE
21 t o Nue-c.4 INAAC..-“c' 90419 caste Srvv&s,urs y IS258 (Zt& )5449 - 34 31
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect 0 Tenant 0 Agent B Other Crrn'Zioc'tae- (too ) Si$ - 53$9
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT 3-'..-.--,r.-. (41.5 ) So t - 11009 tees- rwo c(e wwc,1 se.+v.ce,a
r
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
., ....- ■;DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ ) CJ L ,Q C
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
.
■ PROJECT FLOOR'AREAS•'
AREA DES ION EXISTI 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 =STING PROPOSED TOTAL TOTAL EXISTING SP TOTAL PROPOSED SI TOTAL Sr
"IVEW 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$ (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(Commerdal)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS)or Tub/Shower Combo) LAVS(Bathroom sinks URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Taueq
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify under penalty of perfury 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 aII 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 clai hich may made by any person, including the undersigned, and filed against the city, but only
where such claim arcs of the rel . of the ci , ncluding its officers and employees, upon the accuracy of the information supplied to
the city as a part of .•lication.
SIGNATURE: �( �6.
R I �/ n
DATE l " J 7 t/ 7
..›
Pro.
Owner and/ r uthorized Agent _
m et' .c,ok ug vr;,, .s
o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100-August 16,2007 Page 2 of 4 ' • k\Handouts\Permit Application