05-100635 cm. RECEI'DO5 — 3
Federal Way PERMIT — — `'
COMMUNITY DEVELOPMENT SERVIct i f D 1 0 200.5 j� S I' M F Co M E ]✓i L P L, D E E
332E E FEDERAL
UE SOUTH•PO 9718 1 D {J kJAPPLICATION
FEDERAL WAY,WA 98063-9718 rD /
2"„8,3„5.,2,7,,70.,,-=53-83sraG�9Y OF FEDERAL WAY
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BUILDING DEPT,
The following is required information-an incomplete ap.lication will not be accepted. Please print legibly(in ink)or type.
•.PROPERTY IIITFORMATION
1/ 2-(2:TE.--- D Cr coo-n4 )24-n-1 ej-ra V-P__T SUITE/UNIT#
- ASSESSOR'S TAX/PARCEL# -7L l!L 14-7 14G—_Ll'C,Z - LOT SIZE(s.fi
LEGAL DESCRIPTION (e.g.Acme Estates, Lot 1) cP ATI-beLt.4 ED
/Art rh se rale page for lengthy leg&desoipnonJ
.,:..,r . , ■:.PROJECT INFORMATION'-.
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING RE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
a-KIS r4 cL.., y j (,.. De 'sea t.w_t,'�tZ e S i 1--( Fo‘2 If U9-1 le.300 0
C_O lv S'11Zkk2-rw i L.o'1-SFE,
PROJECT NAME(Name of Business or Owner Last Name)l 6tZAT-10/.1 6790Ar=te -- .&L�1 5
'. .. I. PEOPLE INFORMATION
PROPERTY NeME /PSRIIMARY PHONE
OWNER 1 K�t41,,,� -TN VC-4;1-M elks 1 RoPE.21'"'► S (403 ) till- - Moo
MAILING ADDRESS �jITY,STATE,ZIP
'i n � 4Al ora Port- run m d> QR 9 2:10S---
CONTRACTORco PANY NAME APPLICANT NAME OFFICE PHONE
' l MC_ Pa 04 Atice4 1Nto elb p 'l tic rr tvl 0 Ria t so 1. (2.0>)8Z(.0 -coct9
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
14115 I(o-rti 41- €/k m 7_ SommeR- 1,34 a 33Gtd (ZS1 ) 310 - 3o 44
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER i
/ / (t ) � 1033
B L
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
PI' R S 4- 1 S S R S 1 Z / t t /-24:06
APPLICANT CMPANY NAME APPLICANT NAME OFFICE PHONE
belt- e/NiukesTNta1Bp -62trr- Mom I`.)iJ (2s'.3)?321,0 -on9°\
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
14(Ic- i( -4 1 Stirwc,21031k 083"\0 (ZS ,)510 - 3o44
RELATIONSHIP TO PROJECT FAX NUMBER
D Architect o Tenant ❑Agent yF 'Other(Describe)tOW i-i li}�1-pt2-. (2.‹.- ) &i( ' - 1033
CONTACT NAME,-,
PRIMARYHONE E-MAIL ADDRESS
BP
2T oze_(cco,J (25'3 ) 8Z(40 - 0019
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
' 0 ,I DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ I,1 iO ) —
SPRINKLERED BUILDING? g/YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? .i,k' ES ❑ NO
WATER SERVICE PROVIDER u21-AKEHAVEN ❑ HIGHLINE ID TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ILAKEHAVEN ❑ HIGHLINE ID PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTIO EXISTING SQ.FT. P c.�. SED SQ.FT. TOTAL
• BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE) /
DECK(COVERED?) /
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EXIST,G TOT• PROPOSED TOTAL EXISTING AND PROPOSED
**NEW HOMES ONLY** NUMBER OF BEDROOMS__ ESTIMAT:D SE NG PRICE $
as - ..:.. - ..f...., _EltaintES--, -. -
Indicate number of each type offixture 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 •OLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(Commercial) WOODSTOVES
BOILERS FIREPLACI' NSERTS RANGES MISC(Describe)
COMPRESSORS FURNA S GAS WATER HEATERS
DUCTS GAS ' PE OUTLETS
PLUMBING
BATHTUBS or Tub/ShoaerCombo) SHOWERS WATER CLOSETS Troy t) 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
`fr` 3 g �zE t D SIQrNATQRBBLOCK .t.y ; r
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 e city, including its officers and employees, upon the accuracy of the information supplied to the city as a part of
this applicatio -
< 2 [2? 1�5�
NAME/TITLE l S i ��
DATE
( ignature (Title)
• RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent letit<ntractor 0 Architect 0 Other
i
f
r
{ FOR OFFICE USE'ONLY
a NEW a ADDITION ❑ALTERATION a REPAIR n-TENANT IMPROVEMENT
E BUILDING SHELL ONLY? a YES o NO BASIC PLAN? a YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES o NO
I NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? ❑YES a NO DEMO PERMIT REQUIRED? a YES a NO
f
Bulletin#100—March 30,2004 — Page 2 of 4 k\Handouts—Rcvised\Pcrmit Application