07-105976 CITY OF 1533"'^.w / V s 1 .: I T
Federal Way RECEIVED
PERMIT
COMr'VJNITY DEVELOPMENT SERVICES
. SMF CO ME EL PL DE EN 1'
333258*"v1VENUESOUTH•63BOX9718 2o°APPLI-CATI ON DICT 3 G
.FEDERAL WAY,WA 98063-971 To
253-835-2607•FAX 253435-260 ----Adi --� ' /
WWII/r:i1 gnf(ede:rnhunu.com
CITY OF 1"`lrOERAL WAY\ ' I Nr -..........-
is
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S The following is rega p er(f pn-an i omple a app ca n will not be accep ed. Please print legibly n nk)or type.
. S PROPERTY INFORMATION .
SITE ADDRESS _�M "-WAR C SUITE/UNIT# 1 03
ASSESSOR'S TAX/PARCEL# J CD D J._ D b LOT SIZE s
LEGAL DESCRIPTION (e.g.Acme Estates, Lot 1)
(Attach separate page for lengthy legal description)
PItOJECTINFDRMATIDN • r.,<r
TYPE OF.PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL ffff
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING %FIRE>PREVENTION SYSTEM
PROJ C DESCRIPTION(Provide detailed des ' tion work included on this permit onI
o YAlaln ve: Ag i
PROJECT NAME(Name of Business or Owner Last Name) �w( vLa 1:0-444.14-' / A -
•• PEOPLE INFORMATION ,,A;;,,Y1-
PROPERTY .N M PRIMARY PHONE
OWNER I(' \nie ( ) -
LI�■•' S � � CITY,STAT ZIP �� - E-MAIL ADDRESS
V* al ,
• CONTRACTOR -r.cOOMPPA}N�Y,NAME AP LI NT iNAAM�E OFFICE PH E /}
n+nt�lNG AD S\1 /� -L.+ E.ZIP L C&I L NE
t�� !V
(�� l.J 1..�a 1, -vot I7�/��'{�j ns ( )
-
/ CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER 1- EXPIRATION DATE F UMBER
41' /bl °1 ' no ( Z 31 01 � -LQI
COPY or cord rcgm a . CONT CTOR5 REGISTRATIO UMBER EXPIRATION DATE . E-MAIL ADDRESS
with each applies! ,...,. pc...TS/A Cl ef \ ..?) )(:)..1
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—
APPLICANT COMPANY NAME �PPU NT AME ,NEN
( P OF PHO E /� �j(h
MA ��ATi• Sr. 111
^P n�1 \ CV'/ CELL NE
1)--
iA.LA.ION H T ROJ � ' a r FA )E
0 Architect 0 Tenant 0 Agent ❑ Other ( �n(�-U)/%
PROJECT NAME ��/� r co P,RI RYPH�/E� E-MAIL ADDRESS
l
CONTACT ice; �/' 'Y 1 1 S ` II. I:JV i)
LENDER NAME Per RCN?19,27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
(
. DETAILED BUILDING INFOflMATION =
EXISTING USE ge'(Ipa-i L S{ 0 PROPOSED USE C) 1 C 6
EXISTING ASSESSED/APPRAISED VALUE $ - /71 l-. _ VALUE OF PROPOSED WORK $ /i 2 S0
SPRINKLERED BUILDING? as.,yES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ` YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE411
0 TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑PRIVATE(SEPTIC)
•
r rgst;r,{ st S , I' c ,r •, t• y • .-.• �..,.m•• _..... -
. .w..
AREA DESCRIPT �..
- • EXISTING PROPOSED TOTAL
SQ.FT: • SQ. FT. SQ. FT.
, BASEMENT
IFIRST 1151'6
•ECOND
HIRD •
ADDITIONAL FLOORS (DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
EXISTING PROPOSED TOTAL TOTAL EXISTING SP TOTAL PROPOSED ST "I',7.4.I.
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 aspart of this project. Do not include existing fixtures to remain.
MECHANICAL L_
Value of Mechanical Work $
I/ 2.S Q (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVEF
BBQS FANS GAS WATER HEATERSbt MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(commercial) C1,VitV SPQ1NAttOA.-)
COMPRESSORS FURNACES RANGES
DUCTS;. .. .. GAS LOG SETS REFRIG.SYSTEMS
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PLUMBING
BATHTUBS(orTub/shower combo) LAVS(Bathroom sinks) URINALS MISC(Descrioe;
DISHWASHERSRAINWATER SYST VACUUM BREAKERS
41!
DRINKING FOUNTAINS SHOW ERS WATER CLOSETS(Io leQ
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS i
:, SIGNATURE
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.
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NAME/TITLE `�/0 • 0C r +MGut, •DATE (b-- 30 -C "'
(Signature) (Title)
RELATIONSHIP PROJECT 0 Owner 0 Agent '`Contractor 0 Architect o Other
o NEW o ADDITION o ALTERATION D REPAIR ❑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
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Bulietin#lOf;-January 1.200 Page 2-o 4 k\handouts\Permit Application