07-105646 4
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Federal Wa -
y 2 2Q07 PERMIT SF MF CO ME EL PL DE EN FP
COMMUNITY DEVELOPMENT SER CEIL
3332E 8TH AVENUE SOUTH•Po BOX719718 AP P LI CATI O N
FEDERAL WAY.WA 98063-9718 TD
253-835-2607•FAX EDERAL1i/ /
uw .tryofrza�' BUILDING DEPT.
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS 2_015 PAC I FIC HI6-H'1 -�' FEDERAL LA� �
SUITE/UNIT#_ '-" i ' &
ASSESSOR'S TAX/PARCEL# ( 5600S0 - 0' 1 6 LOT SIZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
❑ DEMOLITION 0 ELECTRICAL 0 ENGINEERING L4.FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlU)
i=1iZE _(-'i( _E2 TEMAN;T IMPROVEMENT NFPA 13 1,,ii--ri-i
9 N ELI A Nab 15 RELOCATE S PR I H/<LE S,
r--'E K.f'l 17 ft 07 ' 10441760 /�R
PROJECT NAME(Name of Business or Owner Last Name) I TE ��v'`
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER H A :x,H ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
OAS PACIFIC HI&HWAYS1 FEDERAL WA`f 12)DE
COMPANY NAME CONTRACTOR E nPPLI OFFICE
(i( l I-IR _ - RO LL_ V [3I(A1-1 SCHUI 7E (T(750Z-
"
- - LS4
O1A CELL PHONE
(5MAILING
O AJOODI NV/LLE RED MOtbIIODD1 ILLI ( ) 403 -01-15RD
0 -15
R SUITE 13 /® CITY FFI WAYLICENSE ER
ZUD -1CEC1OD—EL1 EXIRATION DATE ,071 FAX NUMBER
O
(.1425] `-03-D4( 5
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
(DSCOFPif0NM 0I —(3--(3 r
APPLICANT COMPANY NAME _ APPLICANT NAME OFFICE PHONE_ _
: 1) •h- (RE P';0TCfIDN 131.Z1/14-{ LHVLZ ( =1-�'.._3) 7-�L5-
MAILING ADDRESSCITY,STATE,ZIP CELL PHONE
SAME Ac ABOVE
( ) -
RELATIONSHIP TO PROJECT FAX NUMBER, �-}
0 Architect ❑ Tenant ❑Agent ❑ Other S(...)2rr)lH Tia. VP. ) [i a5 -041E
PROJECT NAME �7 u I PRIMARY PHONE / _ E-MAIL ADDRESS
CONTACT I3( Al�/( /°. OLZ1 (425) B7 - --16.- 4
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
U DETAILED BUILDING INFORMATION
EXISTING USE ' TC)1 ~- M E R CAI ((F PROPOSED USE T E M E R/-/6 6I-47 1 1 F
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 671000
SPRINKLERED BUILDING? C .YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? sl,.YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
It
Ir 0
110
• PROJECT FLOOR AREAS
r
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
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 fixtures to remain.
MECHANICAL
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(Commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toilet)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best of my
knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with all applicable
City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that the issuance of this permit
does not remove the owner's responsibility for compliance with local,state,or federal laws regulating construction or environmental laws.
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, 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.
rZ
SIGNATURE: %L-.. ,.,-Z.,��'7ty j /'r Xs°4 � DATE
Property Owner and/or Autho Agent
FOR OFFICE USE ONLY'
a NEW o ADDITION o ALTERATION o REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES 0 NO
ZONING DESIGNATION CHANGE OF USE? o YES ❑NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? ❑YES ❑NO
PLATTED LOT? o YES ❑NO DEMO PERMIT REQUIRED? o YES ❑NO
Bulletin#100—August 16,2007 Page 2 of 4 k\Handouts\Permit Application