07-104681 IR
• •
pedry or eral CEw so 0 p -7 _LO__ERMIT
COMMUMTYDEVELOPMENT SERVICES
SF MF CO ME EL PL DEE FP
993258'N-AVENUE 77:',ASOUTH 2:83?8 6 7I 3 2007 APPLICATION
FEDERAL WAY;WA 980 B 1U / /
253-835-2607•FAX 253-8099
www,cttuoffederalwau.conl Q L WAV
tTor r4,� ��RA
The follows rsY ( ip
nion-an incomplete application will not be accepted. Please print legibly(in ink)or type.
■ PROPERTY INFORMATION
SITE ADDRESS 3 co O Z ,/cc.-1 F I(J J gnru S TE-1 SUITE/UNIT# f/03
ASSESSOR'S TAX/PARCEL# / S 5 ?. ( 5- o5-0
LOT SIZE(sfl
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING AFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
/FP0177c' 7o , £is77'i , ( nt09-r1441 �si-r 1
PROJECT NAME(Name of Business or Owner Last Name) WI Alf S/ If 1--15.-
1.1
S• PEOPLE INFORMATION
PROPERTY NAME
�`'',', /� PRIMARY PHONE
OWNER l L.C_ T �Q.. -Qua) W• (1. )its-3 -4100
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
91s 1iv - Are, SE_ &Are 300 eat.NoE , wig- ''seS"
CONTRACTOR COMPANY NAME APPLICANT NAME
) OFFICE PHONE
P&-iri taint ¶ eulrLTi t► • 'rim 57`i44%) (2.e6 )781 -3& fc�
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
828 Popt AR. PLs'e £u.Pfb4- c. A-rrue t t. - Nil C ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
2- -0z t&SSI 9 7 ( .oc ) 7z-6 - 81(pct
COPY of card required CONTRACTORS REGISTRATION NUMBER EXP ?THIO DATE - E-MAIL ADDRESS
with eaak application I > PRcl F 5`373 pu.6 1.6/3 o7 i ,niee...PFS. i3Z_
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
PQctFCC 1-i n,E. � S l -roil smi.- 1 (2 i)() 7 8tb' -38'06
MAILING ADDEs S CITY,STATE,ZIP CELL PHONE
822' 9Pu,it Pre 50.7rt} 5--ewine 14' */ i Nil ( ) _
RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect ❑Tenant ❑Agent ❑ Other ee'SPIA.CTrA/L (Z* )rye - $1!o p
PROJECT - NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT --rt IA E MAg`J (ZOfi ) .788 - 3$O( -Lore_PFS •52
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 4 ��'�
�
�/
SPRINKLERED BUILDING? ❑YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
111
•
■ PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
S4.FT. S0.FT. S .FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑.UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS LINO PROPOSED TOTAL TOTALEASTING SF TOTAL PROPOSED SF TOTAL SF
**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 Mein v existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WT17I APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(Commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG Sk.ib REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSLIb(Toilet)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
• • SIGNATURE
I certify under penalty of perjury that the formation 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 p- ises to perform the work for which the permit application is made. I further agree to hold
harmless the City of Federal Way as,t, an claim(including costs,expenses, and attorneys'fees incurred in the investigation and defense of
such claim),which may be made by je • .t,including the undersigned,and filed against the City of Federal Way,but only where such claim
arises out of the relianc e c' , ,i ;fficers and employees,upon the accuracy of the information supplied to the city as a part of
this application.
/
PP drr —
NAME/TITLE
il✓;` 111/ l eir
DATE 3'Z jz'7
iS; e: (Title)
RELATIONSHIP TO PROJEC `D Owner 0 Agent 0 Contractor D Architect 0 Other
o NEW a ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES o NO BASIC PLAN? D YES a NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—January 1,2007 Page 2 of 4 k\Handouts\Permit Application