06-105540 ��Federal Way - - - — — �
�ECEiv��PERMIT R M I T SF MF CO ME EL PL DE EN LFP
COMMUNITY DEVELOPMENT SERVICES T T
33325 8TM AVENUE SOUTH•PO BOX 9718 P T I /�' /� T I N
FEDERAL WAY,WA 98063-9718 j j J /`/'1(.,i To
253-835-26p7•FAX 263-835-2609v.OCT Q
taWWatyoffedernlual.corn L --" ---
The following is required information-an incomplete application will not be accepted. Please print legibl in in or type.
.. ::, •- , • ■ ..PROPERTY INFORMATION .
SITE ADDRESS 3j C(- L �"It'IC.t>-k C1 .SO4 L-}` SUITE/UNIT# - )4104
ASSESSOR'S TAX/PARCEL# ( a S -z- /q — 0 0 J LOT SIZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal desciiptionl
: IN PROJECT INFORMATION •• , ; ._
TYPE OF PERMIT ❑ 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) J
A1- u1-i'cr %'a if k(ST .l e- tiLk'- ,4t- ' i >Li S"�Y- i _ it.)‹.-LA 7 A1eci..1"
PROJECT NAME(Name of Business or Owner Last Name) � ���'' yS ��lt`
. ,_ .• � PEOPLE INFORMATION
PROPERTY NAME - ' PRIMARY PHONE �,,
OWNER (DNS A GILL- (Lac) L S . -�tcX)
MAILING ADDRESSCITY STATE,ZIP
4( t�' (16' 1 Se )0tic3o`� )5 �, , c,A- ggCri
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
PAC t Fi C l 2€ 4. J4tefll ki. 'T4 C"T A� ( )"7 -
MAILING Aers. P C 2 Z_ Pi S CITY,BATE t06- 4 ti (ELL PH C )NE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
7C" -C Z- - ? C 4
5 -tq 1 -B L . / / ( ) -
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
f' c_ ./. 4= p 5 q / 3 P / /
APPLICANT COMPANY NAME _ i APPLICANT NAME OFFICE PHONE
1MAFLU E S4CU/url (k .7701 bisrm ( 2-x(4 -Aa' - 3
MAILING ADDRESS - - CITY,STATE,ZIP - CELL PHONE.
PPpor-a. (k S4 cwA q?14 Ll' ( )
RELATIONSHIP TO PROJECT I - FAX NUMBER
- 0 Architect 0 Tenant 0 Agent 0 Other(Describe)£o i ( , ) 7 - g(160
CONTACT NAME PRIMARY PHONE E-MAIL ADDRES
,tsTi r .( ) 181s - 3,0(c e4 yl�•6i
LENDER '',e, a' d7,�" ( 0 X� i ,x NAME
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) _
■ DETAILED BUILDING°INFORMATION..
EXISTING USE PROPOSED USE ,^
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ e(
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) / l
SEWER SERVICE PROVIDER o LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) �
•
410
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ. FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
"77
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
\limnPROPOSED rorAi ss {
NUMBER OF FLOORS + x , a. ,21N
**NEW HOMES ONLY** NUMBER OF BEDR• MS ESTIMATED SELLING PRICE $
. FIXTURES
Indicate number of each type of re 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(commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSO FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/showe.combo) SHOWERS WATER CLOSETS froert) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Maks) 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 •- to any claim(including costs, expenses, and attorneys'fees incurred in the investigation and defense of
such claim), which may be made by •' •erson,including the undersigned, and filed against the City of Federal Way,but only where such claim
arises out of the r •nes of the ci , • •Mg its officers and employees,upon the accuracy of the information supplied to the city as a part of
this applicati• .
ft q1i q DATE lD,;?�(2
NAME/TI E �° i
(S_ 3' rrw 1_. (Title)
RELATIONSHIP TO PROJECT a Owner 0 Agent 0 Contractor ❑Architect 0 Other
Q 8 0
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Bulletin#100—January 1.2006 Page 2 of 4 k\Handouts\Permit Application