06-104183 REC VE®
EI_ AUG 1 7 2006 /�/„ - / O 4 ' /g3
,..._
oF lJ(.(/
Fmederal Way CITY OF FEDERALERMIT
COMMUNITY DEVELOPMENT SERVICES BUILDING r'rr" SF MF CO ME EL PL DE EN p2)
33325 8TM AVENUE SOUTH•PO BOX 9718 APPLICATION
FEDERAL WAY,WA 98063-9718 TD / /
253-835-2607•FAX 253-835.2609
www.atiio fetferahenq.COM
The
The following is required in ormation-an inco 'lete a••lication will not be acce•ted. Please •rint legibl in in or pe.
M PROPERTY INFORMATION
SITE ADDRESS ciC,Z Cry=, /3 £. 4- 1, S' / SUITE/UNIT#J7%l c7 �'1d
£'. -/�'C
/7 0
ASSESSOR'S TAX/PARCEL# ` -5 an - 0 0 LOT SIZE(sj /
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal desorption)
■` PROJECT INFORMATION ,
TYPE OF PERMIT 1.-71:4, peo/( f 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING E.S FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onitl)
ins{Bucy, tit 3,..,,._ � jye .S".:,dv,-5,,/ 5)0 f,-/ T j4 ue,j
PROJECT NAME(Name of Business or Owner Last Name) A (/10(:) V 0 ►2-L-
PROPERTY NAMEPRIMARY PHONE
OWNER B Oft -a✓ ( ) -
MAILIN ADDR CITY,STATE ZIP
GIkc�' 32'14 S laid_uL ci q 8'(--M5
' CONTRACTOR COMPANY NAME F.- APPLICANT NAME OFFICE PHONE
MD
AILING ADDRESS CITY,STATE,ZIP CELL PHONE
. c. La-C. I(G f- 4..,.2 Ake- &V 'i,!/,,:c (. r[: ) IV 'y 2-.
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
- -B L / / ( ) -
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
/ /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
MAILING ADDRE S CITY,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect 0 Tenant 0 Agent 0 Other(Describe) ( ) -
CONTACT NAME , PRIMARY PHONE E-MAIL ADDRESS
( .<:,f_ .) 2 2_ ?- 52- 95
LENDER ", , 4 A �S*+�,(0311,4 1 NAME
MAILING ADDRESS CITY,STA Y E,ZIP PHONE
( ) -
•
"' 1,+;;•::: , II'DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ /,,,, ,
SPRINKLERED BUILDING? 0 YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
• •
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
NUMBER OF FLOORS =ISHR] PROPOSED TOTAL ?"
**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(comm,rcioi) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Showercombo) SHOWERS WATER CLOSETS(roues) 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
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 `• • DATE tr'- '
(Signature) (Title)
RELATIONSHIP TO PROJECT El Owner 0 Agent 0 Contractor 0 Architect 0 Other
�tF et5 zli pa3, �2t9� ' t ° a � L
�1�.-- eM�' R 4,0
4**1-A \O¢pIZr ir„ lE 4: 0,t,::* v ERYflitoiyil31
ti71lt:7-.)2v:
0 ,:5
�<t ieg ** $ 3 i �51n iif ywg �
'ng'i�*'� si' t �,(` "'� '''�a yam` k -r-r �' �� c � l '" �e rho *ems .�.rF7n �i�'
-Rt� r:l� .,,�t�Lsae«.ir7..�sz.� ���cu�. :^nr,��y*�2er�smr,�.,'.,�"��%5�1� ,aa�:i�W..�����.,� ,,.�:�•� „���;'A��+��; ���.���r7r3a.� �?� � >:\.�°�.7
I..CA L\ A',v.)i^sti,-sis