07-105244 I*
A�-
. a OF A 0.7- 1 _05,R _ c(
Federal Way RECEIVED
PERMIT
SF MF CO ME EL PL DE EN Og
COMMUNITY DEVELOPMENT SERVICES
3332T7 p
FEDERVENUE SWA 980 O BOX 971 r. 2 U P P LI CATI O N
FEDERAL WAY,WA 98063-9718 '"'
253-835-2607•FAX 253-835-2609
u'',t'.cifi'll'dc,'ium''WV C)P FEDERAL,WAS'
The following is requillnan Incomplete application will not ted. Please print legibly(in ink)or type.
• PROPERTY INFORMATIION
SITE ADDRESS_ X06 SO. ecuip.ts Dr,, (�kJ 44. ?PO 13 SUITE/UNIT#
�/ _
ASSESSOR'S TAX/PARCEL# ( / 5 1 2- C) - '7 / 0 LOT SIZE(sf) O/4
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) I/jI'/i/7��I'cluIrA
(Attach separate page for'lengthy legal de doN
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION iELP/rt.lxlttu. 0 ENGINEERING 'FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide// detailed description of work included on this permit onlq) /,/ _
E•f/Ocil t141 /I4L T€rr P_Yr a 74 �\i•2 �_/bu S�.f 7 eYv[ 4� 4)14 co , &
kid/14 / C-4 Urrt •1'74d- /Gr-fr us f,► ...(7~4 chitec-Ac,r /6 C![:c e.uft
7 r Y cy 7-2-" ka*„1 -See".rr j t• -
PROJECT NAME(Name of Business or Owner Last Name) h!(l4 CO riarril
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE u
OWNER /LI GO / -l' (• 3) ye'Z /912-
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
yt S /j„Ila. 4v . aermilleak /OR c r)o7/
CONTRACTOR ! COMPANY f NAME APPLICANT N+WW�E g OFFICE PHONE
4Df 'i&' �w.uw4cetr tt. ha /VI°.��J (z/25 ) 77y - `ID`1`l
MAILING ADDRESS / C TATE,ZIP CELL PHONE
r:, ,,,,,, /y bio Ko '' • W 5'iiii irl / W 1436 (4'z5 ) .5d c? - 772-ZCITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
Cltri ' /9-19 /(951 to/-ov- BL /2/3//2vl)7 ('/25) 77y -63/7
Oe i
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
fR0rEc --/CPS L,j) ,...5/3/A 7 /ykloreco..4.,
APPLICANT COMP NAME APPLICANT NAME OFFICE PHONE
4(Ot 1- &Ia.*:/I S tC `$' M`lr ( *-5 ) 77q/ - q�71
MAGI LING ADDRESS� ,/ CITY,STATE,ZIP �j T CELL PHONEL �/
/971030 YO4 �• hJ NII '-4 414 I�v� FAXNU✓)ER v0 ??2:2-
RELATIONSHIP
?22RELATIONSHIP TO PROJECT /-/
0 Architect ❑Tenant ❑Agent er - /n 0'6"-4•1 ( y,�5) 27y - (--3/7
PROJECT NAME/ /,�/ // PRIMARY PHONE E-MAIL ADDRESS
CONTACT 46 lam''a/C s ( gas) 56 a, - 722 Z �/C••pfoccp.,t6 `mi.
LENDER NAME//v /4 Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
/ • DETAILED BUILDING INFORMATION
EXISTING USE 6/2)040 S-,4 rt._ PROPOSED USE /V4—
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ /CVO
SPRINKLERED BUILDING? ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN o HIGHLINE o PRIVATE(SEPTIC)
•
r • • PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT ,�/
FIRST ZSD� 7A -'"IJ''t 2 j0
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS / f Me�z-
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(commeretal)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSI;Ib(Toilet)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best of my
knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with all applicable
City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that the issuance of this permit
does not remove the owner's responsibility for compliance with local,state,or federal laws regulating construction or environmental laws.
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, 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. 7/2-0/)
SIGNATURE: DATE
Pr Owner and/or Authorized Agent
FOR OFFICE UBE ONLY
❑NEW o ADDITION o ALTERATION ❑REPAIR c TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES ❑NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? ❑YES o NO
Bulletin#100—August 16,2007 Page 2 of 4 k\Handouts\Pernvt Application