04-101029 • COMMUNITY DEVELOPMENT SERVICES
33530 FIRST WAY SOUTH•PO BOX 9718
art of REefilSE) FEDERAL WAY,WA 98063-9718
Federal ERMIP APPLICATION253-661-4115•FAK253-6614129
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For Office Use Only: FW File Number: • . — �0 L 0 L q — ,o-70
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• CITY OF F
SDE AtWA �LL l/ / /
The ollowin. is re•uire in.:l�.'_ Gi ntaCe .lete a..Iication will not be acce.ted. Please .rint le.ibl (in ink)or .e.
p ■ PROPERTY INFORMATION
SITE ADDRESS: 3200M 1 5 . 32 /Wi SUITE/APT#
ASSESSOR'S TAX/PARCEL#: kg q o act - I 4 Q 0 SQUARE FOOTAGE OF LOT: 13/OGo
LEGAL DESCRIPTION(e.g.:Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT(This application): ❑ BUILDING ❑ PLUMBING 0 MECHANICAL 0 DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING$(FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide d ailed description of work included on this permit only): Arid I \oecce hews- ov +1)N• u \\S ._ TUY)
"Petrn4 4 - 03 - 10S58o -oo- CO
PROJECT NAME(Name of Business/Owner Last NamI): 1)r'n,reS.kvf -I uicAnce
• PEOPLE INFORMATION
PROPERTY NAME: ^`� r PRIMARY PHONE:
OWNER Dim ( 1r,lf ' . ( ) -
MAILING ADDRESS REE ADDR S;): CITY,STATE,ZIP
•
CONTRACTOR NAME COMPANY
OFFICE PHONE:
akVi off ya 'Woen-h (253 ) 9210 -2.290
MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP CELL PHONE:
2/07 1O ►�AVe laery ,(A)P 9E42y ( ) -
CITY OF FEDERAL W•` ---INESS LICENSE NUMBER: EXPIRATION DATE: . FAX NUMBER:
1 CI- q L- t d. ( 9 g- .oly \?" /1\ / olv (253) 42-2. - cvlsc
5 4-
CONTRACTOR'S REGISTRATION NUMBER: _ F EXPIRATION DATE:
(copy of card required with each application)F A' 1 Ec D, C i O q 9 C /d / 5 /Cy
LENDER NAME:
(If Proposed Value>$5,000) DAYTIME PHONE:
MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP ( )
APPLICANT: NAME: COMPANY
(ST , OFFICE PHONE:
ohnamok -Pri0 fire Tro C 25' qz
k -
zzio -
MAILING DSS ET CIr �TE,ZIP �VENiNGPHONE:oTO ^ � AP 6 ' � N / ( WIN ) —
RELATIONSHIPPROJECT:
FAX NUMBER:
❑ Architect ❑ Tenant ❑ Other(Describe): (253 ) 922 - b 15G
CONTACT PERSON FOR THIS PROJECT: ❑ Property Owner ❑ Contractor ❑ Applicant AIL AnpREs J
vIng R vrt,re.(1001
■ DETAILED BUILDING INFORMATION
s-m
• EXISTING USE: PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $ /C9) OCC,
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: 0 YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
m.
■ PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTII SQ. T. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
Ill
SECOND
• THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
- TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
HOW MANY FLOORS?
**NEW HOMES ONLY** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
Indicate number of each type of fixture that is to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
COOLERS- GAS LOGS REFRIG.SYSTEMS
EVAPORATIVE
AIR HANDLING UNITS
BBQS
HOODS(commercial) WOODSTOVES
BOILERSFANS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBSSHOWERS WATER CLOSETS(rode) MISC(Describe)
DISHWASHERSIII or SINKS DRINKING FOUNTAINS
.
GAS PIPE OUTLETS SUMPS RAINWATER SYS
WASHING MACHINES URINALS HOSE BIBBS
LAYS(Bathroomsink VACUUM BREAKERS ELECTRIC WATER HEATERS
■ DISCLAIMER/SIGNATURE BLOCK
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 .loyees,upon the accuracy of the information supplied to the city as a part of this application.
/
(974.:,6DATE: 3/2(3/ma
M / ,NAE/TITLE: (Title)
(Signature)
RELATIONSHIP TO ' ' •JECT: 0 Property Owner 0 Applicant 0 Contractor o Architect 0
FOR OFFICE USE ONLY:
o NEW a ADDITION o ALTERATION o REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY?' a YES ❑NO
BASIC PLAN? a YES ❑NO
ZONING DESIGNATION: CHANGE OF USE? ❑YES a NO
NEW ADDRESS REQUIRED? ❑YES. o NO
UP/SEPA/SU? a YES a NO
PLATTED LOT? ❑YES a NO DEMO PERMIT REQUIRED? a YES ❑NO
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