07-106430 CrF1'OF.. 3 — L LL- _Ca 0
Federal Wa .4,0PERMIT
COMMWAYDEVELOPMENT SERVICES
MF CO ME EL PL DE EN ,FP
33325'8TMvIVEM'E SOUTH•PO BOX 9718
I`2 3 835 2 07Y,WA 53063-26 PP L I CAT I ON TD
.253.835-2607•FAX 253.835-26
umiw.rihloffederalwnu.corn
• The foiIowing is r ` irAFittPian incomplete application will not be accepted. Please print legibly(in ink)or type.
• S PROPERTY INFORMATION
SITE ADDRESS 3N5"1 S N.c.4011,1 pwc5 SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 1 S 0 4 C ) - a O 2 LOT SIZE(sJ)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
)Attach separate page for lengthy legal description)
U PROJECT INFORMATION •
TYPE OF.PERMIT 0 BUILDING El PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING F.FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
Ex po f 'A ' - -- -{ -ta NFA ,, k 10, ST y
Ari)OC C 5, A<L EYC1'E Nva 12LN 4(LZ-4kt .. `- .l
Gt.v. fLprtti+rt_ Qik.y to. A.,40 tiZw 1.0"t G-I . Po(-1.c. CANo1°y _.._
PROJECT NAME(Name of Business or Owner Last Name) ST. . e ..S I
CCca Pc-6k
. ,.'PEOPLE INFORMATION ' '
PROPERTY NAME PRIMARY PHONE
OWNER .1(.40 N C.LStCPR t.J AtA Lill 9496'45-w e51"' ( zr i )-t Zt,/ - Ges
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
•
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
"?Ar-'9s - c-xtbx ciLeTLs.Tt.r r.X.. GL.•=NT CA-02 . (ZS S ) 1.7-Ce - 11)1 O
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
pi i 10 .NJ 12 e TAtibMR, U'Pt `'Bk.iZ,-j (Z53 ) (404 - awl
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
/9 -9/ -/0/98e- 00-,Cg1- .2- 31- 07 (zs ) `Izz. - Cotso
COPY of card requiredCONTRACTORS REGISTRATION NUMBER EXPIRATION DATE • E-MAIL ADDRESS
with msk application /'I A=Ct.t00/�t•�^ /0
S.`7{ `O 5--.206‘
APPLICANT C PANY NAME APPLICANT NAME OFFICE PHONE
�k t,sS' cak 11.46 tr�N; ce. O.t44 CMS- (15 3 ) °1ZJCo -7Z4f o
MAILING ADDRESSCITY,STATE,ZIP CELL PHONE
1-1°.1 101 .' A1114 C T PeCA MA-1 w k 184ZL1 (Zs ) o-4?`►C1
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect 0 Tenant 'gent 0 Other (ZS-y ) C,11 - (►S)
PROJECT NAME PRIMARY PHONE
E-MAIL ADDRESS
CONTACT G.ZN-C CAU-- (z53 )gZcc -2:-LcJ cu.c««e„PAttst.-rFsILo.G_a_fJrN
LENDER NAME Per RCW 19.27.0957
Lender information is required if project value exceeds$5,000 . N
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) - p
■ 'DETAILED BUILDING INFORMATION
EXISTING USE 14Cr4CTO-tom PROPOSED USE 14O44'tTA't <NA
EXISTING ASSESSED/APPRAISED VALUE $ - VALUE OF PROPOSED WORK $ ILiS 000k ci
0
• SPRINKLERED BUILDING? YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? (YES 0 NO .
WATER SERVICE PROVIDER 14,LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
4I, ! a I
AREA DESCRIP' EXISTING PROPOSED TOTAL
SQ.FT: • SQ. FT. _ SQ.FT.
B/ 6MENT` •
111FIRST Z( t 5 115 'f' 1 .Soo T
iDECOND loo ril 2 Zj 5oo 1 Z j 2.04, tp
THIRD • \ Zb 1.11/
T Tj . ZD fh Zzl�,t9cp 4
ADDITIONAL FLOORS (DESCRIBE) 4
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT Q •
EXISTINGPROPOSED TOTAL ^*a'-rxrsrmo ST TOTAL PROPOSED ST T . .•
NUMBER OF FLOORS , I 4 12$5 it, 115' >"1 577,$90 i3
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ ..
..
■ FIXTURES `
Indicate number of each type offixture to be installed or relocated aspart of this project. Da not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $ (A COPY OF BID-OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
j
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS .GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(commercioi)
COMPRESSORS FURNACES RANGES
DUCTS, GAS LOG SETS REFRIG.SYSTEMS ,
PLUMBING •
BATHTUBS(or Tub/ShowerCombo) LAVS(Bathroom sinks) URINALS MISC(Describe)
DISHWASHERSRAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS{rot t
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
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.
NAME/TITL — etZ�� " K' -DATE 11-1-9
'8
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent >iii,Contractor 0 Architect 0 Other
o NEW o ADDITION ❑ALTERATION o REPAIR C]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—January 1.2007 Page 2 of A k\Handouts\Permit Application