06-104911 III
CITY eFt I:/ -���]]LLL l- Y q I_.. i
Federal Way
EF 2 7 2006 PERMIT t -1G- co(J
cbMa+uxrrrDEVEcorMExrSERVICES
SF MF CO ME EL PL DE EN FP
33325 8^t AVENUE,SOUTH 9.83 BOX 9718 p p L I C A T I O N
FEDERAL WAY,WA 9 8063 9 718 t OF FEDEF ro /
253-835-2607•FAX2538352609 BUILDING D r' /
}oww,eiftro((ederalway.00m
The ollowin. is re.uired in ormation-an incom.lete a..lication will not be acce.ted. Please •rant le.ibi in in or •e.
;` ;; ■ PROPERTY INFORMATION
3 c C'c' 2- ei.„1, r' f-( (-- ,7 ^ r
SITE ADDRESS , v, J , " J---r-'' ��_ i SUITE/UNIT# A/6C
ASSESSOR'S TAX/PARCEL# 62Cl 5.-
- 0 D LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) Re& rv,( L' �'e'��/jsS i",i c A
(Attach separate page for lengthy f al descnpho,j I
` ` ■ 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 only)
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PROJECT NAME(Name of Business or Owner Last Name) A!3l 14 iA -eJ .4;14,S,F- „
U PEOPLE'INFORMATION . . .
PROPERTY NAME �/ V �i I IOWNERtrt\A ;,*(PR1 VIII C "�� is ,u`n► 4 L'w�i^�lkAA- .i}'� l PRIMARY HONE -
(L , ,� ! ' C(7 Y IP Y ll
`'t0 e ifns Gn a!:' 61),K)4,
CONTRACTOR COMPANY NAME /
APPLICANT NAME
OFFICE PHONE
Y "\re)n (vr� O% \\'\ \1\ CaVCO .Q.- aL
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
Or FED , AYY B�ESS LICENUMB ' ( '-y�vE1l'IRA� FAX
)
TION DATE -- FAX NUMBER
(�--_� i - /�) /
+- " -�-. B L
19-b 1 .f) (.›. )61() - 111S1 ,
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application! EXPIRATION DATE
� 2-1 � q �" �Or-. ,
APPLICANT PANY NAME (�/�� 1 - j� APPLICANT NAME \A)
1 ,'�i}nom? t On\\� . OFFICE PHONE)
MAILING ADDRESS CITY,STATE,ZIP illy )
Cn 11D-14 PAI 0 Q .
F �( CELL PHONE) -
RELATIONSHIP TO PROJECT Fa "' ( l`F NUMBER
AX
0 Architect 0 Tenant ❑Agent 0 Other(Describe) `�` \ v{ (' I' lCj1 p,--( �k �l
CONTACT I NAME PRIMARY PHONE , E-MAIL ISL ASD'``D''R�'(ESSS
(\r\S w I ( I
LENDER .r..,- :4- 3 •`_ 2 at WI. ,,,r., - #/rinnr.-ahl- `x. NAME
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE �n I re-6j( . 5�'`t,t .. PROPOSED USE
f hg.:if Gwsii1s, .
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 1 a ? 7
SPRINKLERED BUILDING? o YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES );310
WATER SERVICE PROVIDER a LAKEHAVEN a IUGHLINE 0 TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) P((7
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ. FT. SQ.FT.
BASEMENT
FIRST /gob 0 e, -
SECOND (� �
THIRD
FOURTH • •
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
EXISTING PROPOSED TOTAL T OPAL PROPOSED eF qP k OPAL 8r S?' -
NUMBER OF FLOORS �. y.';
**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 futures 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(rou<t) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
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 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 % ✓�_ ee-A hle- DATE t .46 f y.
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent 0 Contractor ❑ Architect 0 Other SuhCow%y-'dePr
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4
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application