05-100257 •
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ral
Fede Way 1 14r
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COMMUNTIYDEVELOPMENTSERVICES L.,,,,._., OA' F C• di) LPL DE EN FP
33530 FIRST WAY SOUTH•PO BOX 9718 APPLICATION Tp
FEDERAL WAY,FAX
53-6 1-4 18 1
FEDERAL
I is, 4 ci
253-661-4115.WAFAX 2980 6.9 7 8
wutw.auioffederalwau.a m _
FD�lc. �Pc,AnS T v(eW)
The ollowin. is re•uired to, .F 4.. 'ors P7'..., tt..1S,:'fete a.•lication will not be acce•ted. Please .rint le.ibi (in in or .
PROPERTY INFORMATION
SIT D ,•• • AlIVE„ -:4. 1,-... .IV IIPMAI O
ASS - i L• S (sf
LEG• D RI' • IN, stat .t 1) / _ L k
(Attach separate.. lengthy -...des -ip6on)
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION ❑ ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
CcoSTRuCT k IJE\ ) 4 gEDebeirl.7fr. 5uuq_e_e_ tkt1 c-•/ cip g
Wtm A-r-REb C e -
PROJECT NAME(Name of Business or Owner Last Nam
PEOPLE INFORMATION •
PROPERTY NAME ,` ��• PRIMARYPHONE
��
OWNER `, _ ►l\
MAILING ADDRESS � � CITY,STATE,ZIP 248 -� �
IP5lb eS UTMCEMT gwn Tg3(bi WA. z06395 .
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE •
&_ANsIteet\ YIES)NC "FR-r 51-1E4,. (2.6)248 -2411 _
MAILING ADDRESS
�J'j�/+��� / `'n CCITY',STTATE,,fZIP
W j 1y��Q CELL
�PHONE Q
6510 ED ) 1 BUSINESS
eSEL- \o�Wl�1E NUMBER �XWANCISIVU DATE (20(0)z48241 )
CITY OF AX NUMBER
1 q-i4.-1 O ` 7 ({2 .2.- Li- B L 12 / 30 /O't (2ofo) az -4
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
5c H tsl 2 *, 24 f' 4 / /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
fI IJ U E 2. ROME S 1/416 ' T121UL Zr r e_ (Xe)248 -241 I
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
6510 Sou N TEr2.BGYD .Tutt wItk WA.7tgcle8 (' )24$ - t-7)
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent 0 Other(Describe) (20‘ )24z -4z
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
L a Cot aro ) 242 -241 I PwtRICK rx icte More
LENDER Per RCW 19.27.095: Lenderinforirtaiioniso,.., NAME v .C,j
required((project value exceeds:',$5;0001 gQ4,16
MAILING ADDRESS CITY,STATE,ZIP
DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE SF&
EXISTING ASSESSED/APPRAISED VALUE $ ,97' VALUE OF PROPOSED WORK $21aCia2,
SPRINKLERED BUILDING? 0 YES NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES y NO
WATER SERVICE PROVIDER LAKEHAVEN o HIGHLINE 0 TACOMA O PRIVATE(WELL)
SEWER SERVICE PROVIDED LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
1
3i ) OJcaYSa
2.F Ot k.X T,?'L)IC"'Al Eh')
AREA DESCRIPTION EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL
BASEMENT O 6 O
FIRST ,t' 40,,,,: -42 i: O
. 1531 153
SECOND O ) ZI 0 1 Z(d
e
•
THIRD
.ADD !GklAI FLOORS(DE ,CRI-BE) +
DECK4COVE• IJ '" ` »
GARAGE/CARPORT
629 3 1 q3
6013
HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
"NEW HOMES ONLY"' NUMBER OF BEDROOMS 4 ESTIMATED SELLING PRICE $ A&0, 00 a .
FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICALitI I• � 1
Value t �►le k $ J UNITS 4ATf1O4ERS) ,
� GHODS(commorda1) WOODSTOVES
BOILERS . LACESERTS RANGES MISC(Describe)
COMPRESSORS 1 FURNACES GAS WATER HEATERS
DUCTS 5 GAS PIPE OUTLETS
PLUMBING
2.. BATHTUBS(arTub/show«combo) I SHOWERS WATER CLOSETS(roue) MISC(Describe)
I DISHWASHERS Z SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
I WASHING MACHINES URINALS Z HOSE BIBBS
L/ LAVS(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 o - including its officers and employees, upon the accuracy of the information supplied to the city as a part of
this application.
.
NAME/TITLE //�A _aiDATE )//9/0
(Title)
RELATIONSHIP TO PROJECT ❑.Owner 0 Agent 0 Contractor � i Architect 0 Other
FOR OFFICE USE ONLY
—o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION CHANGE OF USE? a YES ❑NO
NEW ADDRESS REQUIRED? ❑YES ❑NO UP/SEPA/SU? ❑YES a NO
PLATTED LOT? ❑YES a NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100—March 30,2004 Page 2 of 4 k\Handouts—Revised\Permit Application