05-101672 J
Federal Way 1 c0+
,PR PERMIT
SF MF CO ME
COMMUNM'DEVELOPMENTSERVICES . L DE EN )..
.. ,,RST
P0 BOX r' FEDERAL-WI' To
253-6614115•FAX 253 4}Q9l`LMC
1 3 P A P P L I C AT I O N
www.cilyoffederalwatt com
The ollouiin. is re.uired in ormation-an Inco •tete a.•lication will not be acce•ted. Please •rint le•ibl (in ink)or .•.
�� l�`` '' PROPERTY INFORMATION •
SITE ADDRESS 3"I C t '1 00 9't Ci SW) SUITE/UNIT# C4
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sf7
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for-lengthy legal descnpoon)
. - PROJECT INFORMATION
TYPE OF PERMIT o BUILDING 0 PLUMBING 0 MECHANICAL
❑ DEMOLITION ELECTRICAL 0 ENGINEERING p<FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
jrir A(IztA 7r - LOW ✓oC•fl5 t'Z. Icr;l 10 .Ocfs(( y Cx 3-rw\fC if
Az I KOOC sUPPecsSiOt) t rcH ,
\
PROJECT NAME(Name of Business or Owner Last Name)
C
a.V' ( aJ\YY�S
PEOPLE liri^P*lrAT!ON
PROPERTY NAME
PRIMARY PHONE
OWNER N ( O/ L , /
I�( a
MAILING ADDRESS ( CITY,STATE,ZIP ( )
See_ CIrtmoLA
CONTRACTOR COMPANY NAME n APPLICANT NAME OFFICE PHONE
Eire PSC;-)-ecirk 0A lnc j2. y-e54 6Cs�tr),50+� (LlP.5) 240 gloUCS
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
t-7 30 C--- , 65o n Road E of r e-# ( uU A 9 fz 9 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
20 0 — 0 0 - 1 0 2 9 3_ Li - B L / / (412.5 ) 355 - '-15'41'6
CONTRACTOR'S REGISTRATION NUMBER(copy of card regnired with each application) EXPIRATION DATE
L E P t O 2 L M r_ o7/ ,3 /n(o
APPLICANT COMPANY NAME APPLICANT NAME
r OFFICE PHONE
Hese Pro-kciior Inc_ er. r'sc,.. 3014ns6r) (q25) Zrc' - hhaO
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( 7 30 6i bin 6v-riff , wA 9izo ( )
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑ Tenant 0 Agent 0 Other(Describe) (t26 1. 5"'„3 - it54j
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
t
ic 4 L- C;‹�1, (L2 ) 2 5'0t�
LENDER Per RCW 19.27.095: Lender information is NAME
required if protect value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE f
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ t C-5°
SPRINKLERED BUILDING? igYES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE o TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN o HIGHLINE ❑ PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL
BASEMENT
FIRST )
tfl300 _i
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
*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(commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) - SHOWERS WATER CLOSETS(Toilet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Ste:) 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,includi.• its officers an• employees, upon the accuracy of the information supplied to the city as a part of
this application.
n L�
NAME/TITLE411111111° ' ( � DATE I l0c 05
(Signatur- ( Itle)
RELATIONSHIP TO PRO 0 Owner ❑ Agent o Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
a NEW a ADDITION 0 ALTERATION a REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? o YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES o NO
Bulletin#100—March 30,2004 Page 2 of 4 k\Handouts—Revised\Permit Application