06-101065 R EC E I•D _ 0_6_CITY OFJ l /j/`\j�
t Federal Way i'‘,IAR ® 6 2006 PERMIT
SF MF CO ME EL PL DE i FP
COMMUNITY DEVELOPMENT SERVICES
3332538AVENUE SOUTH•POBOX 9718 \ LIGATION TO
`
FEDERALWAY,•FAX29538086335-9276108p
53835260 WA 98063-9718 i
25 �Y®F Ff:,p�•• / /
352607BUILDING
www.cihloJederaiwuti.corn
The ollowin. is re.uired in ormation-an incom.lete a..lication will not be acce.ted. Please .rint le.ibl (in ink)or t .e.
• PROPERTY INFORMATION
SITE ADDRESS CV IJ J (j)Yfl 0al, SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 1 C2 2 2' 4 0 - O v ( v LOT SIZE(sJ)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
.J.N91-(}LL- IE'E SPgiki14-A-ER.S C-ofL &aFss gErwEcIJ -r4E Cr—"nic rs
4 A)E„nl CF nl Tu R 1-t T i4 A-T L.E.S
/PROJECT NAME(Name of Business or Owner Last Name) ( ifi t lei,t( 1 r t(..%c
• PEOPLE INFORMATION
PROPERTY NAMEPRIMARY PHONE
ST
OWNER `/` / �4s-r M P I( ( ) -
MAIILING ADDRESS CITY,STATE,ZIP r,/
14 Z$ S LJMMO,S -I- �v1-rra,
eaG✓�"i OA- 918 CO
CONTRACTOR COMPANY NAME APPLICANT N OFFICE PHONE
'Et e. 5P2ikh6t•�it-S T .. ex,..e_ A' .'R.s�w (Z3 ) ,z.c. -00..i
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
(c.14 No.w.1.34- c,-r-- 51/4)1rlN .-4 W 'l83% ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
B L
/ / (253 )31e -4405-
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
/ /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
( ) -
MAILING ADDRESS ANC_C, _ CITY,STATE,ZIP CELL PHONE
\s1\L (
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect 0 Tenant 0 Agent ❑ Other(Describe) ( ) -
CONTACTNAME PRIMARY PHONE E-MAIL ADDRESS
4,,,....€
��%,�L- (Z�3) 8u -0059
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
/�,� U DETAILED BUILDING INFORMATION
EXISTING USE (Y\A-Ll.... PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 1 14, SO°
SPRINKLERED BUILDING? YES u NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? kriES 0 NO
WATER SERVICE PROVIDER /AKEHAVEN ❑ HIGHLINE ❑ TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE a PRIVATE(SEPTIC)
• •
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 ❑ CARPORT❑
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 $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commeroiaq WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(orTub/Shower combo) SI lOWERS WATER CLOSETS(Toilet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAYS(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. Q ��
NAM2E/TITLE DATE �J/6lC 4
(Signature) (TItle)
RELATIONSHIP T PROJECT 0 Owner ❑ Agent 7tontractor ❑Architect ❑ Other
FOR OFFICE USE ONLY
o NEW ❑ADDITION ❑ALTERATION ❑REPAIR TENANT IMPROVEMENT
BUILDING SHELL ONLY? J YES
BASIC PLAN? ❑YES u NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? ❑YES ..I NO UP/SEPA/SU? o YES ❑NO
PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? a YES ❑NO
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application