06-100165 RECEIVE• (150
emoF JAN 1 3 2006 II `r — P 121 1,_-_-5
Federal Way.
COMMUA77YUBVELOPiN8NPSERVICES PERMIT
1 1 OF FEDERAL Wpy�F MF CO ME EL PL DEE P
33325 8Te AVENUE SOUTH•PO BOX 9718
2°� °�� 2APPLI CA L . D DEPT. TD
859
/ /-
The allowing is re• fired information-an incom'tete application will not be accepted. Please •rint legibly in in or ty•
• PROPERTY INFORMATION
SITE ADDRESS /320 $ 32. / _s---7- SUITE/UNIT# /J'/J
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
6t for
W iapaldeaaip6aQ
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING . 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING AFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
/rvs rr9L.C_ $eel/v17(.-tel$ /9T cv v7S4 )6.- &‘,,g Ul-r- Gui9 y
d v 7St 0 a'�.. F PO c l-f iii5 C49-S I N 0
PROJECT NAME(Name of Business or Owner Last Name) F Pc c N c5 C/9:S l/v b
U PEOPLE INFORMATION
PROPERTY . NAME
PRIMARY PHONE
OWNER 1419g-j.LAA I )-t V h.S j /47hiv-7 P f ( ) -
MAILING ADDRESS CITY,STATE,ZIP
) 00 .s. 32-(1(14-57: tom, 911003
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
V I)TI r(& 5eg)N Itis Ce.)_ 1401A44(2.0 1r PiAr,r (zd(o ) bZZ - Ll 425,1=
MAILING ADDRESSCITY,STATE,ZIP CELL PHONE
-I
3 / /
AV5• 5A492714-2-, , c9),34 (oto) C/L -/9 z
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER ..., EXPIRATION DATE FAX NUMBER
Zd_ 0 /- l 0 2Z 5 "7_B . /L/ ,3/ /0L, (20C ) - °.31'I
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
/ /
APPLICANT CO NY NAME APPLICANT NAME OFFICE PHONE
(1,,7 1i' ) ( ) -
MAI 0 ADDRESS CITY,STATE,ZIP CELL PHONE
( ) -.
RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect ❑`Tenant ❑Agent 0 Other(Describe) ( ) -
CONTACT N E j PRIMARY PHONE
E-MAIL ADDRESS
LENDER
, ,<?a f e4,3 °. x a- , ..fad° e)(4 I ej / 'I Iaj it" J
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) _
■ DETAILED;BUILDING`INFORMATION:r
EXISTING USE ,/dl/ liffeiii PROPOSED USE I v
//__ 7i��
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ S& • D
SPRINKLERED BUILDING? 'YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED./REQUIRED? EYES a NO
WATER SERVICE PROVIDER 'LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 4AKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
•
411
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED '•TAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
•
FIRST
SECOND
THIRD
FOURTH
•
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?) •
GARAGE 0 CARPORT 0
- Ig0lTIIIO !AOlOeiD TOT :c, cj . 'ac±e,' ;
NUMBER OF FLOORS I
**NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be• •tailed or relocated as part o ••is'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(commecdot► WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING '
BAT VBS(or Tub/shovrorCompo) SHOWERS WATER CLOSETS rros o MISC(• *be)
• 'HWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Snail 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 oft city,including its officers d employees,upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE DATE 1 )i,/Ofc'
(Signature) (Tim)
RELATIONSHIP TO PROJECT q Owner 0 Agent *Contractor ❑Architect 0 Other •
4:y. •.�: .3:` J_J: :' v_.33",9�' :�1'. 1.a 3 ��.. .\ �1"1 �n;�.?i .1..�_`:.o i;:
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