07-104091 ...- al
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oi _ i_ 0109 /
O PERMIT
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Federal Way 1:te--
SF MF CO ME EL PL DE EN
30Tov98 i 11 I 2,007
325DEvE= sx7cE44
FEDERAL WAY,WA 98063-9718
2607FAX 253-8353u% .. LICATION 3 . t
253-835 * -2609
.... twp
www.cilmWederakvau com
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The °now • is r-• tC-A ;AL,:t.11.'ion-an incom•fete• ••beat ion will not be acce•ted. Pie. ='• "nt le."•I (in ink)or ty••.
• PROPERTY INFORMATION
SITE ADDR , _
- ,--,N, , - i:)Zkair- SI--
ESS i-1 C-JC; _; SUITE/UNIT# of (.)*F
ASSESSOR'S TAX/PARCEL# / S- C) C. 5-- C) _ C:, cl.. ? (--,:i
LOT SIZE(si)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) C-t- CQ -A/TV:42-- '1?› Q(-- 3 1.
attath separate pogefcr lengthy legal desolption)
NI PROJECT INFORMATION
TYPE OF PERMIT 0 BLTILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION ELECTRICAL 0 ENGINEERING XFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit oniti)
0
tA-0
--- ',
)
PROJECT NAME(Name of Business or Owner Last Name) 0,,,,r, f..,,,n. s 2
Ai PEOPLE INFORMATION
PROPERTY NAME
I PRIMARY PHONE _
OWNER
1-4-PrZSC 14 _ -Ct ( C1.). , .t.,"- i 6--..) LA-<--- I ( )
MAILING ADDRESS- (j 1 .CITY STATE.ZIP--.
' '''-,,,,
',.
CONTRACTOR COMPANY NAMEr
APPLICANT NAME '" OFFICE PHONE
...titv._
MAILING ADDRESS rili R,I: (CO )
CITY,STATE,ZIP
CELL PHONE
I, vi
( 72 Ll' (,:-‘ P)S'elit ''-:1 3 (.,--.-- L4 ''' ' '''''CA
( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
L .I (L, 7.— Li i. V-13 L t / /,
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application)EiRA
TION DATE FAX NUMBER
1)' I e— C- il :r * f) Z A L
2, 3 j .: , c3
) 3 s-
EXPIRATION DATE
-7 / 1 '3 ic7
APPLICANT COMPANY NAME ,
APPLICANT NAME I OFFICE,PHONE , e
17-1,i'.1.-.C.-- r-',..:,--1::Z-.:1-,br'• ---tiA. .1-1A-Cr,-,V: ':.:1-NIVI-z,- C--> I N z:i. ) 2 ',,::- tOoc. I
MAILING ADDRESS
CITY,STATE.zip
CELL PHONE
,
--_3 c (.17 i,23 St;t,,, R i) IL ‘ i e, 6,-- k ( ) _
RELATIONSHIP TO PROJECT
FAX NUMBER
61,--
0 Architect 0 Tenant 0 Agent At:Other(Describe) ----,-..,,i 5; 4 r e_ '.(71.) ri2s:I:35—)- ‘-(5—Yks
CONTACTi I PRIMARY PHONE ,..NAME1 -:‘) i' ':•1' - -Lf I ErIvIAIL,, „AD, (rE,S, .,S,, , .. ,_ , , ,./ _ ,i
_ f---i; >L.ti ti c L --
,./
LENDER Per RCW 19.27.095:Lender information is NAME
required((project value emends$5.000
MAILING ADDRESS
CITY,STATE,ZIP PHONE
) _ 1
a DETAILED BUILDING INFORMATION • •
EXISTING USE P) e'''CC, 1) PROPOSED USE
't
-.1 <-' c-•'-'
EXISTING ASSESSED/A4- i PPRAJSED VALUE $ VALUE OF PROPOSED WORK $ r e.- .,a 4- •
SPRINKLERED Bump/NG? RYES 0 NO FIRE SUPPRESSION
wnmpiwpompi 0 yEs NO
3(k,
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEFTAVEN 0 ELIGIHINE 0 PRIVATE(SEPTIC)
I
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
BASEMENT SQ.FT. SQ.FT. sq.FT.
SECOND i .Ne‘,./ _ ( L 1.-7
` `s)GI r, „.... L L` i ')
L �% t /
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS I =SLIM I P1DD 1 ram TOTAL LEI.SMa SP
TOTAL PROPOSED sr TOTAL
"NEW HOMES ONLY" NUMBER OF BEDROOMS _ ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type ofjirture to be instal)Pd or relocated as part of this project Do not include existing
MJfixtures to remain.ANICAL
Value.of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS
BBQS REFRIG.SYSTEMS
FANS
BOILERS FIREPLACE
(commerclsl) WOODSTOVES
FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS for Tub/Shower Combo) SHOWERS WATER CLOSETS crow MISC
DISHWASHERS SINKS (Describe)
DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom sines) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished .
I a.:_ ayrr,,v.:va.r '"• •`- ----- - �me is true and�r-.�o�..r r."thp.,s.,...
the.caner of rice atone premises to perform the work for which the it of iy knowl ge. and further.that I
harmless the City of Federal Way as to any claim(including costs, attorneys'
Peng ur eon is made, t gati n defense
hood
such claim{),which may be made by any person,including the undersigned. �i and aagains s'fees incurred is the investigation erg defense of
m
arises out of the reliance of the city,including its o - and employees. �file against the City of Federal Wap but to only where such claim
this application. • upon the accuracy of the information supplied the city as a part of
NAME/TITLE / DATE ��"
,,. (Signature) (Otte)
RELATIONSmI rO PROJECT 0 Owner ❑Agent Contractor 0 Architect ❑ Other
FOR OFFICE USE ONLY I
a NEW 0 ADDITION ❑ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES a NO BASIC PLAN?
ZONING DESIGNATION YES o NO
CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? o YES a NO
PLATTED LOT? UP/SEPA/SU?
a YES a NO
aYES ❑NO DEMO PERMIT REQUIRED? o YES a NO
Bulletin#100—January 1,2006 Page 2 of 4
klIiandouts\Permit Application