06-105261 RECEIVED 0la- I
Feel�"^�
Fe l !4-,
ralW y� s Zoos PERMIT - -� �,�
COMMUNI7YDEVELOPMENT SERVICES SF MF CO ME EL PL DE EN �J
333258TH AVENUE,SOUTH WA
BOX 9718 AppLICATION
FEDERAL WAY,WA 98063-9718 J ERAL TWAS ro /
• 253-835-2607•FAX 253-835-6091 NG DEPT
/
Iuww.nt ualfederalm6 -tJ
The ollowin. is re uired in ormation-an incom•lete a..iication will not be acce•ted. Please •rint le.ibl in in or
_• • ` ■ PROPERTY INFORMATION
SITE ADDRESS ! tic f I C w S
ASSESSOR'S TAX/PARCEL# V f SiT# I
t '-�- -1-Q�� C.4d• LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) F2Ot e +
,( V'V -e s ,� QAldi A
(Attach separate page for lengthy legal description/ �f �.l
. ■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING iii FIRE PREVENTION SYSTEM
O
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
"`sI,C. ... r w d, `
1�.� Y' C�v�Yep !�
PROJECT NAME(Name of Business or Owner Last Name) N \"\Y K_S, l'\/c----.12C1k
• PEOPLE INFORMATION . ..
PROPERTY NAME.
OWNER \A
1� ��� / PRIMARY PHONE
MAIL N i AD IIcS Al fVl jl Illi/ A"),p 1
• `r Y (' CITY.STAT.Z[P ( 1
Ali\f Y.�
CONTRACTOR COMPANY NAME APPLICANT NAME
krAr `' 1�,��`{,- r } (OFFICE PHOONN`EE.. R Y � � "1`^ LJ �ST71TE; 4 ! /Ul if
�1 -- - ` CELLPHONE
CITY F FEDERAL WAY BUSINESS [CENSE NUMBER EXPIRATION DATE FAX NUMBER
Ll _9 L A .IS '-B' L /-- i I ( ",)q3� Q tSD
CONTRACTOR'S REGISTRATION E TRATION NUMBER(c( .S2-
oopy of card`required with each application)
-i-\ L� 1 � 1ERd 1 ri /b/EXPIRATION DATE
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
CITY,STATE,ZIP CELL PHONE
@-)m i -�\ lk., E. '7LCYY�l 1l�Udq-" ( ) -
ELATIONSHIP TO PROJECT
(( FAX NUMBER
0 Architect ❑Tenant o Agent 0 Other(Describe) `c [,� �� ���� 4
CONTACT I \tr\ \ \N) PHOYE-MAIL ADDRESS
1 . 7‘/
E
(PRIMARY� . Q- l .
LENDER aU� � F3g z2�oz. - vx_� r( ni aK7 j
NAME
MAILING ADDRESS
CITY,STATE,ZIP
1 DETAILED BUILDING INFORMATION
41rISTLNG USE I( a,\ . PROPOSED USE ale. _, /,L a
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 9,800
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES a NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ IIIGHLINE ❑ TACOMA ❑PRIVATE(WELL) /
SEWER SERVICE PROVIDER a LAKEHAVEN 0 IMMUNE . 0 PRIVATE(SEPTIC) cbS q
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 ❑ CARPORT 0
EXISTING PROPOSED TOTAL 4 O�t y OTALPROPOSEDsF f ,445,:.:. ALS,► 4
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
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(orTeb/Shower Combo( SHOWERS WATER CLOSETS(Toike 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
ant 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.
C
NAME/TITLE DATE
igna u (Title)
RELATIONSHIP TO PROJECT • •wner .gent 0 Contractor 0 Architect 0 Other
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Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application