06-100081 FF 6
.dF
-N._
RECEaVoft _ i_
CIT'f OF /2 QQ $ J
Federal Way PERMIT
COMMUNITY DEVELOPMENT SERVICES JAN 0 9 2006 SF MF CO ME EL PL DE E
3332FWu+AVENUE SOUTH•PO BOX 97.18FED E.,AP P LI C AT I O N
FEDERAL WAY,WA 98063-97}¢ TD / /
( 253-835-2607•FAX 253.8352 �T OF
www.atuoffederalwau.com. BUILDING D Vl/,q '
The foilowin• is re•uired information an incom•tete a••lication will not be acce•ted. Please •rint legibi in ink or 1•e.
® PROPERTY INFORMATION
SITE ADDRESS. 3372.5 / s T VV4Y S O V 77-1 SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 61 2 6 5 v 4 - O 1 U LOT SIZE (sfl /IC,277
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) wFST dA rn PUS e tc E AR K bill £ Lo r /9—
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING lit FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this oermit on/10
ADP / RE Loc4TE FtR.e SPR(NKLE2S Fb/Z -rg7V4NT fik.f PizovEmENT
PROJECT NAME(Name of Business or Owner Last Name) F 2 gslbE LbA I,M
li PEOPLE INFORMATION
PROPERTY NAME77�� PRIMARY PHONE
OWNER F.SI A /3U/Ltd/A/Gl , LLC- ( )
MAILING ADDRESS CITY,STATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
7>4T/2/or F//2E P/ZOTCCr-r/0"/ (Z53 ) 'Ls - ZZ40 il
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE l
2707 -7o 174 AVE £QST %Acop\A , t y4 96'1Z.L/ ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
/ 9 - I / - l 0 1 9 8 6 - B L ) / (Z53 ) 9ZZ -6( 50 '
CONTRACTORS REGISTRATION NUMBER loopy of card required with each application) EXPIRATION DATE
l' A T R t F P o g g c F / /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
_SA ML Fv4K .BouL,clNyEn_ (z53 ) Z64 - 34165
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
SAM 1_ (Z53 ) 405 - 0763
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent liti Other(Describe)Su/3GoW TRALT (Z53 ) ZS'% -3cf 66
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
a-T.'4.nv .3ouz.4 N4 a"3L, ( ) - Qvo.v0 i p(.tr at.ct re.co..—
LENDER ,Per.RCW;i9 27 0.55 )Lendertizformatiorzis „ NAME
`iregtYir d ,pro"ject waluesexceer ,i#,D00 g'T,
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE 0 rr(67 PROPOSED USE Off/C-L
EXISTING ASSESSED/APPRAISED VALUE $ 3,U 271 'F 00 VALUE OF PROPOSED WORK $ Z, 'ZOO
SPRINKLERED BUILDING? E YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
s
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 0 CARPORT 0
EXISTING PROPOSED TOTAL ''TOTAL'EXISTINGSP `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 2 Zvi
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS)Commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES /Z MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS ti •//12
PLUMBING
BATHTUBS(or Tub/showerCombo) SHOWERS WATER CLOSETS(roiley 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.
NAME/TITLE �/" � jA)e---11-- DATE /. q. 66
(Sim (Title)
RELATIONSHIP TO PROJECT ❑ Owner 0 Agent ,Contractor 0 Architect 0 Other
Na'ORaC1FFICEn�fISE�N,I3x'�,�,i . ,;��;
o.NEW ::.ADDITION o:ALTERATION o'REPAIR •tfTENANT'IMPROVEMEN'1
BUIL DING'SHELLIONLY? OYES "a NO BASICIPDAc ;, ,-.o YES
"ZONING;DESIGNATION CHANGETOP USE? o YES -,°IN0.
NEWADDRESS REQUIRED? -o'YES o:NO" !.""UP/SEPA/SU? atEES 'nNO
PLATTED.LOT? ❑TES ❑`NO •DEMO:PERMITREQUIRED? OYES '' °110
Bulletin#100—August 19,2004 Page 2 of 4 k\Handouts\Permit Application