06-100913 CRYeGF RCG�,,,�v 4 —
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�" lileral WayP -f-
�� l v PERMIT SF MF CO ME EL PL DE El�
C0601111077116VBLOPf EM'BERMES
33325 BM A SOUTH•P 9718
FEDERAL WAY,WA98063-9718 PLICATION
To
•2534352607•FAX 253-835.2609C1TY OF FED
clw,atuwfederr,urau.com DUiLD)NC3
w
The following is re,uired information-an inco •lete a.•lication will not be accepted. Please.•rint legibly in in or type.
1111 PROPERTY INFORMATION
SITE ADDRESS 3222 5 F'AC-/F/L. /.//4/4w4 se S 0 SUITE/UNIT# )0
ASSESSOR'S TAX/PARCEL# / 3 0 0 5 0 - O ( d O LOT SIZE(4) 36�5 2-
LEGAL
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) 8 /o,I t,AND rt._ ce N-r
/A paga.hr+010vrlegal dreaiPtionl
IN PROJECT INFORMATION '
TYPE OF PERMIT 0 BUILDING . 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING b FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
)(bib �ptt1(.11�LEIL 1=011 TENANT IhP(LoveT+.t-,4-t pert_ v-IFPI. �3
•
•
PROJECT NAME(Name of Business or Owner Last Name) 1" M -S hi-4) �V
II PEOPLE INFORMATION
PROPERTY . NAME PRIMARY PHONE
•OWNER HMI-cc-irk 11JV ES T Mf N'C p 0.o --1)--1"I ;-c.p (So3 ) Zit Z -Z90 e
MAILING ADDRESS CITY,STATE,ZIP
VIZI SW SI�L1.+�oN ST port_TLA ORE_ZyoN 1IZ05
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
?(NTR_ FI E QR-GTL-Z7IoJ t ' t.) It, (z5-1)(zs3) gz-6 -ZZcto
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
2_7 C>-7 7o-r"-+ AVEC "7" c.o M Q ,WLR et 8(42_9 ( )
CTIY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
(253 ) qZz - 6/SO
B L '
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with*ink application) EXPIRATION DATE
P A T \ F 12' o y 9 C- F
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
-SEE A13ovE ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑:Tenant Agent ❑ Other(Describe) ( ) . -
CONTACT NAMEPRIMARY PHONE E-MAIL ADDRESS
E144 /V .c3ove-4 Ny4 --- ( zs ) e✓2_6 - 'ZZ4 o evo..1S@(•,w,rtr;of�1r-e,co"k
LENDER
MAILING ADDRESS CITY,STATE,ZIP PHONE
• ■ DETAILED BUILDING INFORMATION` ` ' „
OXISTING USE N4 PROPOSED USE t/A in_ - A Lo N
EXISTING ASSESSED/APPRAISED VALUE $ N 4 VALUE OF PROPOSED WORK $ 3 2-00.
SPRINKLERED BUILDING? `6\YES ❑NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? iikYES 0 NO
WATER SERVICE PROVIDER WLAKEHAVEN ❑ HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
111/ •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL 40
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
•
FIRST /TE /U I LF 5Q
SECOND
THIRD
FOURTH
•
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
zasrmo PROPOSED
TOTAL �.:; .,,,3 f
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 include existing,f fixtures to remain.
MECHANICAL 3 7O O
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commerdel) WOODSTOVES •
BOILERS FIREPLACE INSERTS RANGES /$ MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS F(RE S pet N KL EA-S
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(.rTub/9hoaercombo) SHOWERS WATER CLOSETS Rad) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom •) 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 toperform 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 DATE z . Z'f • d 6
(Signature) (Tttk)
•
RELATIONSHIP TO PROJECT q Owner tlikgent 0 Contractor o Architect O Other
0`,r.`,;, 1?333._ rk
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i ' J3--J , `"5�<'� y ,1�.�,". ,J:r .>x5�r;.> i`: �*.�- <...., 1 D�%J X��°L,,\)/0
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Bulletin#100—January 1,2006 Page 2 of 4 k\I Iandouts\Pennit Application