06-106128 «,_o. 41._� R 9 - L 0Iiq g
Fec,eral Way 0 4 2006 PERMIT
COMMUNITY DEVELOPMENT SERVICES pi..- SF MF CO ME EL PL DE EN FP
33325 817,AVENUE SOUTH•PO BOX 9718
253D83 FE607•FAX 253-ERAL WAY,WA 8 2609co 9718
F��11." ? liL I C A T I O N 7D
• Www.cituofTederalwau.com G. 014ow.
� ` / /
The ollowin. is re•uired in ormation-an inco •lete a..iication will not be acce•ted. Please .rint le.ibl (in in or •e.
'`` ;` - PROPERTY INFORMATION '
SITE ADDRESS 2_ -1 -?aU-h S' € / T# l
ASSESSOR'S TAX/PARCEL# -
t �-? 1 � -.. (Pell LOT SIZE(s�
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) F;-0/. .I 1"./.4.,y e l^G5S►`H•f 4 A
(Attach separate page for lengthy legal des ,ption) J
. ■ PROJECT INFORMATION .
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING �Q FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit maul / `
(A Ye4- 1 re . — -
, �i„�
PROJECT NAME(Name of Business or Owner Last Name) � �r, _•PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
WNER �.� ` "' i Y
Irak —mlAINGADD rk� V 41 (h � CIV4 AT '�1 ( _
'-'3C-n>5. - a..(,\� 1c , w - (2)KT6 -
CONTRACTOR COMPANY NAME APPLICANT NAME I OFFICE PHONE
__?fiAcacli.Arliol_ciivi \ J .-
""• ^"""� �CITY,STATE,ZIP
CELL PHONE
\AprictS
—CrTY//O��F FEDERAL WAY BUSINESS LICENSE NU�BER EXP TION DATE - FAX NUMBE
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application( - EXPIRATION DATE
Z A—T �.- F ' (.� • L .i—=:. / /
APPLICANT COMPANY NAME
APPLICANT NAME OFFICE PHONE
rn
'� Az 11 LQ- -
A ADDRESS {i ����
l:� CELL PHONE
IONNSIP O P O �� ��1, ( WPr ( )
FAX NUMBER.
0 Architect ❑ Tenant ❑Agent 0 Other(Describe) (4 .5)/r`) -LQ'
r
CONTACT M\''\ ,-Y‘ril
r, PRIMARY PHONE E-MAIL ADDRESS (�
t.,3 ( - ID.
LENDER :y,7..cl,, 11•4)-,. :.'oY);,"a. '1'17i,2137".,f•fii"to al i,.'3 NAME
h,i I t,,f{_,•I•,it 4 K-s. t •;%,11,1,0,1A; --_
MAILING ADDRESS CITY,STATE,ZIP
• - • DETAILED BUILDING INFORMATION
STING USE eyk(' q At fa,/t S�,u� PROPOSED USE Re+c)0'I sire.
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ I /9 5
SPRINKLERED BUILDING? ,, -fES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 131IO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
, SEWER SERVICE PROVIDER 0 LAKEIiAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
•
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ. FT. SQ.FT.
BASEMENT
FIRST l V�/� U •
60
SECOND V V
THIRD
FOURTH
•
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS erasrtxa PROPOSED rorv �uarf r aru.raotroseosr6 stY•d
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
i.. .
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 CLOSETSfol<) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom sib 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. It 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 �l. G"" e5 h DATE —
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner 0 Agent ❑ Contractor 0 Architect k Other Sl,/7 Ioi rrc4 v
lac T e �iRa cz' 03L>?
@ a* ellet t"(lJi( la� iAcVo • li +tL +���f�Ptt1 �e > ,' 4
�( ux �c 41 A, • oI
ff >L
0; ,f;� � 'i��f�Y� 0)J �...�. �F ° ..��
i ial,.�1.(,-s" o-51.. #;� oa ty e 7 ok? r�.y r aZi "i,
°
�)fi�'�1F'f °�6,1s�� •.!�-j ...: � fi t J� -C J r 6 �'j3G�C�i��D Y�' sk ",�,aa.. e 1.�r � � �
Bulletin#100—January 7,2005 Page 2 of 4 klHandouts\Permit Application