05-105481 Ot*.- ioup
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CITY P RISC L° S �rS t
t Federal Way PERMIT
COMMUNIATY DEVELDPMIJVI'BER F CO ME EL PL DE EN FP
33325 DERAL WAY.WAIIT•6397 2 5 2°°A.5'
oo I,PLI CATI O N
FEDERAL WAY,WA 98063-9718 • ?
253-835-2607•FAX 253-835-2609 j
• 1��
www.cituoffederalwsra�v OF FEDERAL WAY '- c,.
The ollowin, is r v I)i in-an incom•fete a, •lication will not be acce•ted. Please ' ' t le•'•1 (in ink)or j,
• PROPERTY INFORMATION
.�
0 ♦
SITE ADDRESS / Q SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# / / O j e7- / 6 0 LOT SIZE(s,)
LEGAL DESCRIPTION(e.g.Acme Est-ores,Lot 1) 6611.ELI9-- -S'T,¢-TSS Ler-7- .# <W)
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT Er�UILDING l TPIUMBING El"- CHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
7-1A/4-£'r ,e aol> ,e41-4i `5'//V— -,'/4- SEs/A G
J/1//7 471. ,q --',, - ' -ii' ..v_ 4.' G4._5//V
LE1/4-T/dN NfW -rie G -7--m /.
0sig : Oz/-/D4//� p44-A/ :c--76, 2.7.) ��v. :, -
PROJECT NAME(Name of Business or Owner Last Name) Ci(/.LL=LL/ E 7--,4-7 4,77-4;&- R.()
• PEOPLE INFORMATION
PROPERTY NAME
PRIMARY PHONE
OWNER LS en/.. /344/4.T rDiw > /Ne-- • i z,iI (.53) F4-r-40e
MAILING ADDRESS CITY,STATE,ZIP
P •.56X T 17.1'd f'ur,a// Gii,41- 7y 73
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
66-mE- s ,-ova ,e /_4'__/ t Y - ( ) ..ext.--,1
MAILING ADDRESS CItY.STATE.ZIP CELL PHONE
// /1
( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
p-D .--/<i- / 2r B L / / (063)501-0 / 1.
CONTRACTOR'S REGISTRATION NUMBER(copy of card requited with each application) EXPIRATION DATE
s'a a 67 e /Y 6 /g 9 / /O / a5
APPLICANT COMPANY NAME APP CANT NAME OFFICE PHONE
LS'oIM/2 Z34a4.T dVE5 /(eL/_i Z),y ( ) 1/ -
MAILING ADDRESS / CITY,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER //
0 Architect 0 Tenant ( ent o Other(Describe) ( ) _
CONTACTNAME L L/ PRIMARY PHO E-MAIL ADDRESS
y� Jp53) xf 8'- O ��o /tie/% u,7abu,/thonxs .,,iy/
LENDER Per RCW 19.27.095: Lender information is NAME[ A /
required(f project value exceeds$5,000 /7- 41E--�-r-P -7" rnr'Y
011
MAILING ADDRESS
CITY,STATE,ZIP
tom'�'
33/5 s. ,e r�5-6--. toe TI�COr1/7-, A4.91- 91410 5
Al • DETAILED BUILDING INFORMATION
EXISTING USE /�! , / PROPOSED USE (. ' / • S/E • -, ..107 .0-
EXISTING ASSESSED/APPRAISED VALUE $ Y/� VALUE OF PROPOSED WORK $ [Z2Z , )
SPRINKLERED BUILDING? ❑YES t�NO e FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES V
WATER SERVICE PROVIDER leCAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER IrIKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
, V a
t PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
-pi. FIRST
/,?&) T /,,,z(-r? Iopt
/3 ,7 i,:--- --S77,...----
FOURTH 6z,„I 1%
t‘ ,1
ADDITIONAL FLOORS(DESCRIBE) (`
,DECK(`COVERED?):4)6 Q 4 �
t GE : • ..rRT❑ 6-- r-" / / 6/
�r
NUMBER OF FLOORS NUMMI PRO TOTAL®SMB P, TOTAL 1- 2401.
°f a
"NEW HOMES ONLY"" NUMBER OF BEDROOMS ESTIMATED SETTING PRICE $ - ,777):5D__Vi)/MY)
�1 ` C
FIXTURES
Indicate number of each type of f fixture to be instnl!Pd or relocated as part of this project Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $ 7/ a w h
0 AIR HANDLING UNITS a EVAPORATIVE COOLERS GAS LOGS e/ REFRIG.SYSTEMS
O BBQS _, 5 FANS a HOODS(cumme,ciat) a WOODSTOVES
O BOILERS / FIREPLACE INSERTS / RANGES O MISC(Describe)
D COMPRESSORS / FURNACES / GAS WATER HEATERS
/
/LQ DUCTS / GAS PIPE OUTLETS
PLUMBING /
BATHTUBS(orThb/shower Combo) / SHOWERS WATER CLOSETS gimlet) D MISC(Describe)
DISHWASHERS / SINKS O DRINKING FOUNTAINS
GAS PIPE OUTLETS D SUMPS O RAINWATER SYST
/ / WASHING MACHINES 0 URINALS ,c,: - HOSE BIBBS
LAVS(Bathroom sint®) 0 VACUUM BREAKERS d 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 q f 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 �.4// ��77/rSD4f/VD7jG6/4-7-/1/2),/i '/�'V DATE ./0(Signa ) (Title)
RELATIONSHIP T OJECT 0 Owner tle4ent 0 Contractor ❑Architect 0 Other
FOR OFFICE USE ONLY
0 NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? ❑YES ❑NO
ZONING DESIGNATION CHANGE OF USE? o YES ❑NO
NEW ADDRESS REQUIRED? o YES ❑NO UP/SEPA/SU? ❑YES ❑NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100-January 7,2005 Page 2 of 4 k\Handouts\Permit Application