08-100340 CRY OF.A' a \ 0 C) ` 0
Fed raIWay17CEI rPERMIT
COMMUMTYDEVELOPMENT SEPVICES SF MF CO ME EL PL DE EN FP
333258171 AVENUE SOUTH.PO BOX 9 71 8 10
FEDERAL WAY,WA 98063.9718 N 2 2 20 p p L I C AT I O N TD
/ 3 It t
253.835-2607•FAX 253-835-2609
www,cituolTedemlwau.com
The following is re eft'Wformation-an incomplete application will not be accepted. Please print legibly(in ink)or type.
a PROPERTY INFORMATION
SITE ADDRESS 7-S C 5 S �j-3')-Com- 5" SUITE/UNIT# 3 0 C
I Z�
ASSESSOR'S TAX/PARCEL# . 7 2 .- SL/� 3 c LOT SIZE(sf 7 S. cs+1 I
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) r F7)C-12--A(-- tLJ A`7 c E-A-- 7 E/2—
(Attach
2(Attach separate page for lengthy legal description)
. ■ PROJECT INFORMATION •
TYPE OF PERMIT GILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
eif-t_ 1> GNC- elGf-/LES DEi�C 'r'c•rJv trJ44,4_� 4C 4Gt-r9-T-
2 voo as ( th:VIA.ai)
PROJECT NAME(Name of Business or Owner Last Name) sg t- `7 G—,-
M PEOPLE INFORMATION
PROPERTY I NAME PRIMARY PHONE
OWNER ) i V 7Nt/6S7/-'/fi1,-%% l_ 1_ c__ (2`;-_q 2- ?7 -5 0C)F,
MAILING ADDRESS CITY,STATE,ZIP ` E-MAIL ADDRESS
2scc S 32c`— rz y
. s 7co . Fe/4/4--02.4-L._ w1+
J-.4-L ,6 tA4 Ig(cS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
L'Gti/ t. 6--ii__ ( )
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
( )
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
SA w4(- ti r ,413. 'E ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
LIC C: ) 77 - 3b77
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent..k3"G'ther D6.✓ '6 .- (2C 3 ) 2 3-7 -SGx`
PROJECT NAME 7f9 PRIMARY PHONE E-MAIL ADDRESS
CONTACT S1°14 .-s;T JC -,L-I-1 (j..-�- ) -/ F. - 30`7-J KG.toisk Se;L �c 11-I.;, 7i air,
LENDER NAME ,�;p Per RCW 19.27.095:
-003 krie., ' Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
I )
a DETAILED BUILDING INFORMATION •
EXISTING USE ir; f-1 i -E PROPOSED USE C f /e.... -----
•
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 5 4" 1) ‘✓
SPRINKLERED BUILDING? .4-TES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES O NO
WATER SERVICE PROVIDER frT AKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER . ttKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
AREA DESCRIPTION EXISTING
PROPOSED TOTAL
BASEMENT SQ. FT. SQ. FT. SQ. FT.
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
I ZXISTZaO I PROPOSE, I TOTAL
TOTAL==IRO ar row,PROPOSED Cr
TOTAL Cr
NUMBER OF FLOORS
"*NEW HOMES ONLY** NUMBER OF BEDROOMS
ESTIMATED SELLING PRICE $
IIIIIIIIIIIIMIIMIIIIIIIIMaallMMIIMI.MIIII
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$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS
BBQS GAS PIPE OUTLETS WOODSTOVES
FANS GAS WATER HEATERS
BOILERS FIREPLACE INSERTS MISC(Describe)
COMPRESSORS HOODS(Commercial)
FURNACES RANGES
DUCTS GAS LOG SETS
REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or rub/Shower combo) LAVS(Bathroom sinks)
DISHWASHERS URINALS MISC(Describe)
RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS
WATER CLOSETS(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.
SIGNATURE: ` I C
• Owner DATE i/2- ;I/C C .
petty Own
�,. a or Authorized Agent
1 �1 �
y � L `
k *�a e i1lH.,(P� u�, akti4� da
❑NEW a ADDITION ❑ALTERATION a REPAIR "'"___
o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN?
ZONING DESIGNATION a YES a NO
CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO
UP/SEPA/SU? ❑YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT
REQUIRED? a YES ❑NO
Bulletin#100—January 1,2008 Page 2 of 4
lalandoutsTermit Application