07-104698 - III III
geeEiv
CITY OF • - V
Federal Way AUG 2 4 200/ PERMIT — — — —
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE EN FP
33325EDE8T"AVENWAYUESOUWATH•98063PO i8I'BOX8 97J 11F FEDER ,PPLI CATI ON
FRAL 7n `- `"/ N....N....253-835-2607•FAX 253-835-2609 O I L D I N G D /
www.cifllolledera(wau.com
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS '214 I, I 6t tiiLt6 SUITE/UNIT# A YV`G�1A�Eti�Zlt
` L -�
ASSESSOR'S TAX/PARCEL# Cl 2" 4' ``) C' �1 t, 0 +� 0 LOT SIZE(4)LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (,-)1 C v'�
(Attach separate page,for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING TFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) ((
F 1r4.. A l Ari v--. 1 17-4 -vii-V :-w . ', 1 tje,:v ,� w,t _ � ,
,-1,' ";LAOk,< , ,
r
PROJECT NAME(Name of Business or O er Last Name Ni N Y c t j•I a �`a Si f yvv 1 -f { S Ll'?4J'y/� Ci Il(- l ,1 .
am u., ` Pi-Y`I F(C., �fb ktA� 1 /k,(•... oce, ' i.>i t�1 t,C. J o
• PEOPLE INFORMATION
PROPERTY NAME `9 � + ,` A��" PRIMARY PHONE
OWNER V I (�knA� 1`' tt,b( r1 ( ) -
MAILING ADDRESS)` �� ryfTYt STATE,ZIP 1 ,��4 E-MAIL ADDRESS
CONTRACTOR COMPiANY NAME APPLICANT NAME 7 tI 'rt OFFICE PHONE 1�
4 12)04,ILC I✓l eeC.krt C- ,,I t c,i i ovu4t ( (2,,:;2 ) ') (e' -c, 14t{
MAILINPCG )D -7101 `)Act, ZIP wiC `l1 G ( `,3)NE -
CITY OF FEDE WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
11 - 611 • (U`] UL (26,)`$ 1 -P-ft-g'
corY of c.ra requ roa 1 CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
with e®ch application i ✓ K LIQ e 0 E.C_0 Lo7 ijA [ II I c S
i
APPLICANT COMPANY NAME APPLICANT NAME 1, 1 OFFICE PHONE
� ��,i+C���+ t�A.v�t� (` �(�
16-0,11/11 - 1. �e1 r (Ulf)) 'Z'7( -i''k/
MAILING SADDRESS
P.Q b J 41 101 V C t&- tZI�',P- �� l�l OS (`ELLL'�i tE L1 0- 14t i
RELATIONSHIP TO PROJECT Il FAX NUMBER
❑Architect D Tenant VAgent 111 Other 60-0 SILL V.) COOkYd.C.1.61( (16.0 .7M1 - is o
PROJECT NAME PRIMARY PHONEE-MAIL ADDRESS 4
CONTACT 1�GL G V ( 2C1,$) '2511
Zl-( - iN6c‘ lil&v avi )(.What .044'1
LENDER NAME Per RCW 19.27.095:
N)it Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
■ DETAILED BUILDING INFORMATION _ ,. ,
EXISTING USE Q ' (.4-'iQ 4.. PROPOSED USE I-1 et- -V`Lw-tea
—
EXISTING ASSESSED/APPRAISED VALUE $ ;v)i'- < VALUE OF PROPOSED WORK $ I-i two ,
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? b YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE o TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND yzill
THIRD � .
ADDITIONAL FLOORS(DESCRIBE)
•
DECK(111 COVERED OR ❑UNCOVERED?)
GARAGE ElCARPORT 11NUMBER OF FLOORS EXISTINGPROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
■ FIXTURES
Indicate number of each type off(xture 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(commemaq
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo)
DISHWASHERS
DRINKING FOUNTAINS
LAYS(Bathroom Sinks) URINALS MISC(Describe)
RAINWATER SYST VACUUM BREAKERS
SHOWERS WATER CLOSETS(-Met)
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/TITLEO'Vlti b1 T J\ 1 LY ✓' IV\-10 L" •^(11 11 (AAA. e_ DATE J '
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner 0/Agent /Contractor 0 Architect 0 Other
FOR OFFICE USE ONLY
❑NEW n ADDITION
BUILDING SHELL ONLY?
ZONING DESIGNATION
1
❑ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
❑YES c NO BASIC PLAN? ❑YES o NO
CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? ❑YES ❑NO UP/SEPA/SU? ❑YES ❑NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? ❑YES u NO
Bulletin#100--January 1,2007 Page 2 of 4 k\Handouts\Permit Application