06-100072 RE GEN ir
1' —
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Federal Way PERMIT ?"i4 1i I, 2,.-
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE E FP
33325 8TH AVENUE SOUfH•PO BOX 9718
FEDERAL WAY,WA 98063-9718 AP P LI CATIO �- L 1NP1Y
C� U IF LD I ,NODE D('EPT.
253-835-2607•FAX 253-835-2609 / /
mow.ciluol)ideratwat.corn "7/,
The ollowin• is re•u' ed i ormation-an incom•tete a••lication will not be acce•ted. Please •rint le•ibl- (in ink)or .
• PROPERTY INFORMATION
SITE ADDRESS ,..-.5 PA-C..4 CI L- 14141,44,../4%•t S as lra4 4.3 SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# d e' 2 1 0 4 - "1 t Z. D LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT ❑BUILDING ❑ PLUMBING ❑ MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu) Q
A%1 �'Cl) PEdDFNTs iu N{c,(+� (. Et&..1iJcos 1 >( (QEkJ gekhiv. -1-1-
PROJECT
=PROJECT NAME(Name of Business or Owner Last Name) Pp(..t't C_ ,y NT'(G+2.l�A'Tl QA k t-- l&e}Ai le--
II PEOPLE INFORMATION
PROPERTY NAME ___ PRIMARY PHONE
OWNER NAME.
QSG.Nt ,.,L NV E4 1 J PK 0 Pfc(2T! T> ( ) -
MAILING ADDRESS CITY,STATE,ZIP V 2 ��
PO ga K Zoo Poi--n_A,J o
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
El et Pie i t1 k-,..tem a—Ne.... 441....e... &A- of (z.5 S) S T.I. - 6o T/
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
(ac3 ) '?74.) -4 4 a S"
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
'Z. o -Q c- 1 o v_ 1 3-B L t Z/ % t /6)(i (2 s3) eel.' - (v 33
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
F 1 R C 5 1 9 $ e e.. T (Z / t 1, /<i-o.
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
( )
MAILING ADDRESS 7 A A.i1,//( CITY,STATE,ZIP
CELL PHONE I
RELATIONSHIP TO PROJECT /� FAX NUMBER
0 Architect 0 Tenant ❑Agent Other(Describe)�.Z7 k -CrOd - ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
''ca.., 9,Oi^1 (tS, ) 1514 - 0094 oKL.fcf3-FSLQCoiAcAST/k
ir-
LENDER Per 1927 005 4n-formation is NAME
,
required>4 f protect vale^ 'eeeds$5,000-
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE , 1'M V PROPOSED USE BA-k)14-
EXISTING
A k)14-
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 3 SOO
SPRINKLERED BUILDING? l4(/YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? (yYES 0 NO
WATER SERVICE PROVIDER [ LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
•
PROJECT FLOOR AREAS
OTOTAL
AREA DESCRIPTION EXISTING PRPOSED
SQ.FT. sop
FT. SQ.FT. ,
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
NUMBER OF FLOORS
EXISTING PROPOSED TOTALrtrrar e�asT sr' TOrwvracoeoeeosr C4rat Sr
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type off' re to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(Commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS R.-nth/ SHOWERS WATER CLOSETS(Toilet) 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 erjury 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 or- 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/TITLE N V DATE / / d
(Signature) ('rile) !!!
RELATIONSHIP TO OJECT ❑ Owner ❑ Agent ontractor ❑Architect ❑ Other
ca NEW a ADDITION a
ALTERATION PA
,aTENANT IMPROVEMENT'
BUILDING SI ELL NLY ' n YES a Nf� ... €.. •.-- t N ,. _ "❑YES t�NO,
ONIN DESIGNATION C iNGE Or USE?' ,YES a NO`
NEW AD
REQUIRED,,T 'SES NO UP/SETA/SU? ti YES a NO
PLATTED:LOT? o NES a NO :. DEMO:PERMIT REQUIRED? d YES ❑PYO
Bulletin#100—January 7,2005 Page 2 of 4 k�JJandouts\Pennit Application