05-105020 RECS/EDI 16 �
CITY OF� -
Federal Way SEP 2 PERMIT - -
COMMUM7YDEVELOPMENTSERVICES 9 2005 SF MF CO ME EL PL DE EN F
•
33325 8TH AVENUE FAX
•p0 BOX 9718 , P L I CATION
FEDERAL WAY,WA 98063-9718:;j y OF FE p E p
• 253-835-2607.WAY,
FAX 253-83 / /
WWII,cityoTfederalway. ,m BUILDING DEPT. /
The ollowi • is re•uired in ormation-an incom.lete a.•lication will not be acce•ted. Please •rant le.ibl (in in or .e.
■ PROPERTY INFORMATION •
SITE ADDRESS /"72S Sa,A.-1 ly C6'•,})ns 11.E �+(
- SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 7 Co A O 4 b - 0 n ( 0
LOT SIZE(4)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page far lengthy legal desolpdon)
:■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL -
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0,FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
i?< <ce&.+ e„ac.,•s1.'.:.a 10" Fi z.r.. ,......: .. 10,4 c� 4sr>z,.<-f '
I .oya c:4
do./0iL010 5 e'..--) t' M (u(L.f Y1..e.,....T r .c_
PROJECT NAME(Name of Business or Owner Last Name) Gee,-14+.1 11 ec,11 y.e- �
CrpwirKexJs y�er2A� WJ✓+f
. `; ' : � PEOPLE INFORMATION
PROPERTY NAME
OWNER PRIMARY�/� PHONE
MAILING ADDRESS ��E 2 y `/ / ( 05-2- - ‘,74,0
CITY,STATE,ZIP
Zc'/// 5.1.4 3•a c.-). 5i- s ko
;4.e to I /`1e.--t.,!-a 7.."T" aa..Q-<.k 14 At
CONTRACTOR COMPANY NAME APPLICANT NAME
!OFFICE PHONE
.5"-D-77sa.ee,•.-' 4e /7/
A-4//e., /12',., Fxekso",( '/2r)�s`?' -so38
MAILING ADDRESS CITY,STATE,ZIP
� CELL PHONE
S / A
/T`/. i/' f< SqE 5.E &-Yea W//4• 98001/ (:Zoe. ) 8s 4- - /z/-3
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
CONTRACTORS REGISTRATION NUMBER(copyB L / / ( '/2s-) PRA' z
of card required with each application) EXPIRATION DATE
APPLICANT COMPANY NAME APPLICANT NAME
OFFICE PHONE
SEEwfl rhs-f ZOP�ie- :Gs 4 ri-r)c.r.- G....erzY ( )
MAILING ADDRESS CITY,STATE,ZIP - CELL PHONE
5Hn1i< As 4sseue ( ) _
RELATIONSHIP TO PROJECT
0 Architect 0 Tenant ❑Agent (e Other(Describe) 6ado ' FAX NUMBER
1
CONTACT I NAME PRIMARY PHONE
I E-MAIL ADDRESS
I �d''-' ) 3 VS - SG9 4/ S r e.�. M u3 r.e,
LENDER ; ¢s..aa:. :L�x
r o a NAME
MAILING ADDRESS CITY,STATE,ZIP
• . iii DETAILED BUILDING INFORMATION
•
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WO
$ !9 Soa
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED ,
/RF�QUIRED? TES- 0 NO"`"
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAKEHAVEN 13 HIGHLINE 0 PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
•
•
EXISTING
AREA DESCRIPTION PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
7 •••
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
MISTING l+ROPOS!D TOTAL TOTAL"LXISTQI6 AL TROPOSED Sr p OTAL 6r.` •`4'+. ,`
NUMBER OF FLOORS ` ' ? �;
she. .
**NEW HOMES ONLY** NUMBER OF BEDROOMS f ESTIMATED SELLING PRICE $
FIXTURES •
u
Indicate number of each type of fixture to be installed or relocat•: as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS GS REFRIG.SYSTEMS
BBQS FANS
HOODS(c. mat) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(orT�b/shower combo)
SINKS
SHOWERS WATER CLOSETS mii,t MISC(Describe)
DISHWASHERS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom S olcoj VACUUM BREAKERS ELECTRIC WATER HEATERS
I
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 aboveipremises 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 �� � 4
6 � �z••e! �a DATE L Y •a 5'
-------P° (Sign ture( //
(Title) ,///
RELATIONSHIP TO PROJECT 0 Owner ❑ Agent 0 Contractor 0 Architect ❑ Other C�n 5 u (�a
7-10
,m 7.�'" F , rean y "4"°—SAY &` ,,, ,.
�,-- ® €L.,,,, v , i ;;-.; '?�1;... � Fo, �..-. .:.-,,,,L ,t,�,xa,E • .�i�3. u k - ®"ILIO,ii,,,
�r� Y. b 1 jj �`� ,,.4,1...144.4i..,,,-,,,„::, u .u, �—��# PA�': ,n �`��� �` ,`�" -f.ru� ,,g-"..,,,,,..7r,--- .':Y. • ® 0 3^�f'�`
fA ,, , w: .e �. "e ° r n ° n® a° 1• µ-77,47›. 0,/tea, d` .° �'.- ,,t
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application