05-101727 EECEIVED • 1to. - 3
APP o cs 1 (7 l 7 2
CITY OF, 'T rift,!'
Federal Way PERMIT SF MF CO ME EL PL DE Er FP
COMMUNITY DEVELOPMENT SERVICES CITY OF
33325 AVENUE SOUTH• BOX 9718 A3� I A TION
FEDD ERAL WAY,WA 9806363-97]8 TD / /
253-835.2607•FAX 253-835-2609
wwuycit uollederalwau.com
The olIowin• is re•:tired in ormation-an incom•tete a••lication will not be acce•ted. Please ,rint le,ibl in ink or t i.e.
• PROPERTY INFORMATION
`t'`�
SITE ADDRESS\ `'`�a 3' 34• 'S '' -•, 4 f �' SUITE/UNIT#
0 J� t
�-
ASSESSOR'S TAX/PARCEL# 2 2 I v ci ) (J LOT SIZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates, Lot 1)
(Attach separate page for lengthy legal description)
III PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
0 DEMOLITION O ELECTRICAL ❑ ENGINEERINN—cJ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only) _ff
\O Y" � It,, J + II w dam► 1 E}. . .t,4-r'3�ct..1l C
wycA ..e R - rc 'c� ►�t�� yun . ern i cy
VD X11 Q:1 =.s • V n Qh Cie t r -, Q pct L C�.1v-F) (\!f a : *1 .-..
I ......... ....... �,- r 1 I
PROJECT NAME(Name of Business or Owner Last Name))L`-'� 1 aa-62 r t!/l(�V 1I
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER °�{1�� Q,H l�Ll�= �(11c'(-0(-0J _ cr'+'`�rn L tI ) -
MAILING ADDRESS CITY,STATE,ZIP
'
CONTRACTOR PANY NAM CANT NAME OFFICE PHONE
L MAILING ADDRESS 1_ _ ? CITY, Ttoct Cis - CELL PHONE - -_
CITY OF FEDERAL WAY BUSINESS LICENSE NUMB_FER -) EXPIRATION DATE FAX NUMBER
1_CL- Si 1 -0 0 0 OS J ' L 12-13 1 /054''''' )C-(a‘ -a-350
CONTRACTOR'S REGI ON NUMBER(copy of card required with each application) EXPIRATION DATE
Sm 1 -r - I ? (P 0'T" 1) / 'O'
APPLICANT s OMPANY AMEA PLI CANT ARAE OFFICE PH
,iin
t('C)1 50---0.--i,' 3 (--) 14.. (a55)
AILING ADDRESCITY,STATE,ZIP CELL PHONE
111166((JJ)�,//,y, �✓—D - 1(T C ` '� ( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent 0 Other(Describe) ( ) -
CONTACTNAM PRIMARY PHONE E-MAIL ADDRESS
�� kc_) r
, ) X31 `o4.: - 1:0
LENDER Per RCW 19.27095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION r
EXISTING USE PROPOSED USE •' ) .
C � iliF"
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 20, PO
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? DYES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
a • • •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ.FT. SQ,FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE O CARPORT❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SP
**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 $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(com),,,c(q WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower combor SHOWERS WATER CLOSETS(Toaet) _ MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks) 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 employees,upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE �,4t1)Cc \ DATE 4/1:51(0 D
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent ❑ Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
a NEW ❑ADDITION a ALTERATION a REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? ❑YES ❑NO
ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? o YES 0 NO UP/SEPA/SU? ❑YES ❑NO
PLATTED LOT? 0 YES o NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100—August 19,2004 Page 2 of 4 k\Handouts\Permit Application