08-103323 ede IVEli PERMIT S FCOMEELPLDEE FP
COMMUWIYD
• 33325 FEDERAL
UESOt71N•POBOX 9718 8 APPLICATION
FF.DERALWAY,WA 9806;33.87]8 / /
253.835-2607o•FeAr
uurtu - eX2u3-6a3.540Q O 9 2008
The oilowin• is -- _ a: :y , 'Ica corn•fete •w iication will not be • •., .ted. Please tie! .1- (in ink)or _j, .
22 • PROPERTY INFORMMATION 0 �J,.-�
SITE ADDRESS i) �`J PC`--�4/�c 14(A-11 q`] . SUITE/UNIT# .d1
ASSESSOR'S TAX/PARCEL# i 5_ r� (i , (a- C s C) 0- LOT SIZE(sj)
LEGAL DESCRIPTION(e.g.Acme Estates.Lot 1) C ntL� LO b.;
Nttadi�tepgX kealdewgSnJ
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION)(ELECTRICAL 0 ENGINEERING it FIRE PREVENTION SYSTEM
PROJECT FIESCRIPTION(Provide detailed description of work included on
O I r 4c_s o 'x 1 s N v,.N .` i&- , .
PROJECT NAME(Name of Business or Owner Last Name) 5L ^
0 PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER Tis On_ C + f" t 4 I W LLC- ( ) -
MAILING ADDRESS CITY,STATE.
P.0 . a ,() T-q-2.06
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
ire eG - . ',\-4(-1•�hn (LiWN'O -9
MAILING ADDRESS. -,f CITY,STATE.ZIP �+ CELL PHONE
1 a) (1\��7i > . Yl E-trewre t\r uk9g3` '`f ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE - FAX NUMBER
2-- Q-.0 (1-1_ Q. LI i ( -$ L r Z/ 3 1 "08 (z-(Z5) 353 - (1-514 Co
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
i PrOIY,&hbn.
, C:. �eDk51Yl ( (-ZS)Zjo --q
MAILING ADDRESS CITY,STATE.ZIP CELL PHONE
( ^.bn RA.ye4 ,reAri}t.( ?g)(5
( )
RELATIONSHIP TO PROJECT . FAX NUMBER
0 Architect ❑Tenant 0 Agent , t Other(Describe)(11X') e I/VC (1 )-j-3 - g
CONTACTPRIMARY PHONE E-MAIL ADD
NAME�\o\J6v(=o(=of)n( (4 7 0 D
1J ) -7(0ro(�-gyp( se ttlr. Cf611
LENDER Per RCW 19.27.095: Lender bijbnnagfon is NAME
required ifpnzfect 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 $ c7(A.)• OD
SPRINKLERED BUILDING? Iiif YES ❑NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES O
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
•
' PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. Sg.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH •
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS 1sm19f6 PROPOSED TOTAL TOTAL=ORM" TOTAL PROPOSED B TO`'""
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offvdure to be installed or relocated as part of this project Do not include existing fbdures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(cow WOODS"!OVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Sha,erCombo) SHOWERS WATER CLOSETS miles MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAYS(BatmoomSinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I cert(fy tauter penalty ofperlury that the information furnished by me is true and correct to the best gf 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,andilled against the City ofFederal Way,but only where such claim
arises out gf the reliance of the city,incl 4, its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application. J
NAME/TITLE t ')° e �/� (� �7(
(Signature) q V v DATE '�/f v/✓ L�
Mlle) ///
RELATIONSHIP TO PROJECT ❑ Owner ❑Agent Contractor ❑Architect o Other
FOR OFFICE USE ONLY
a NEW o ADDITION n ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? n YES a NO BASIC PLAN? o YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? n YES n NO . UP/SEPA/SU? a YES o NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—January 1,2006 Page 2 of 4 Id Handouts\Permit Application