06-101052 e CRYO' R aECEly
Federal Way - 1— I 2"'
COMMUNr1YDEVELOPMENTSERVIC III
PERMIT SF MF CO ME EL PL DE EN P
333258TMAVEUESOUIH•POBOX9�AR 0 6 2A�PLICATION
FEDERAL WAY,WA 98063-9718 3 / ' /
FEDERAL
253-835-2607*LWAFAX 253-835-2609 0
ummo.cihwllederatmau.mElTYYg OF FEDERALn�pWAY
The callow' is iced lip N SRI.=T•on incom,tete •f,iication will not be acre,ted. Please , 'at le!'•i_
Cutink)ort_y-.
t� e� • PROPERTY INFORMATION /
SITE ADDRESS 3'2 z 5 ? (2- � 5- SUITE/UNIT# /v V
ASSESSOR'S TAX/PARCEL# I S- 0 b U - h l (") C) LOT SIZE(s)
LEGAL DESCRIPTION(e.g.Acme Estntps,Lot 1) IV/k
(Atladt separate page_far lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING ARE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
L a u Va l 1-d. Fi c - AiI4t,t-vii 7:'r
PROJECT NAME(Name of Business or Owner Last Name) ✓//ow- 4 �r Z>-7I
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER e ve l ekte 7 (4 )S5Cp - loot'
MAILING ADDRESS CITY,STA ,ZIP
I'�%ACD ME Wt£.. 3NS-c) 1e.li•tvLAC, vty14 q g eS"
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
pt r2, Mrd kc-1)`01-7 ic. r (�1Z5')2`10 -�(t,,bO
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
113e� A'.bscv K:c ..cel Lve�-re. am- 9f` .0 ( ) -
CrIY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
._ —p c -.1 Q '� -B L 12 - /3 1 /2-06G9 (4231 V3 - `'16�-ke
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
E L >� r `P r lr- o_ & i t i L- 07 / 1 '3 /OC9
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
iIIr-e, Fr 21ec t`a�-1 �� , (417,5)-2- 0 - 9
RESS ' CITY,STATE.Z�I CELL PHONE
1730 �i r b � Cti E�ve4rrP A- Ztq ( )
a_
RELATIONSHIP TO PROJECT //++�� FAX FAX NUMBER
O Architect 0 Tenant ❑Agent [Other(Describe) C Hyl17a--C (Z6-1 36-3 -145-1-fie
CONTACT NAME PRIMARY PHONE E-MAIL ADpRESS
?t' S .6---r— P.156 ('lzc) 2�7z' - ?(,00 A:„. r—
LENDER Per RCW I9.27.095: Lender information is NAME
regi lred Cfp%iect value exceeds$5,000 /V JP"
MAILING ADDRESS CITY,STATE.ZIP PHONE
N/la' ( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE ''/55 CY S PROPOSED USE A-' i
EXISTING ASSESSED/APPRAISED VALUE $ 01 (1 f n VALUE OF PROPOSED WORK $ /- 7 e-2.,-2., .15`).15`)l
SPRINKLERED BUILDING? OYES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES fr o
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
• •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
BASEMENT - s9.FT. SQ.FT. 8Q.FT. _
—
FIRST _
SECOND
THIRD `
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS
EXISTING
TOTAL TOTAL ausflNG$r TOTAL raoro�sr I Z
i
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ *---
FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project. Do not inchirie existing fixtures to remain.
MECHANICAL �/
VahiP of Mechanical Work $ f V -A
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS ICommenla)) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower combo) SHOWERS WATER CLOSETS(lbw) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAYS(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
arisesout
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
of the reliance of the ci •'hiding its officers and employees,upon the accuracy of the information supplied to the cityas a
part of
this application. ."alj
NAME/TITLE a e� DATE _Vi/6 6
(Signature) fink)
RELATIONSHIP * PROJECT 0 Owner o Agent Contractor ❑Architect ❑ Other
FOR OFFICE USE ONLY
a NEW a ADDITION o ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES a NO BASIC PLAN? a YES a NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? a YES ❑NO
Bulletin#100—January 1,2006 Page 2 of 4 k\Handouts\Permit Application