05-106412 W
CITY OF RECE \]r
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FederalWay 200- PERMIT — °1---?
1 9COMMUNITY
SF
8TSF MF CO ME EL PL DE EIV FP
33325 "AVENUE
SOSOUTH•PO BOX 9718 APPLICATION
FEDERAL WAY,WA 98063-9718 253-835-2607•FAX253-835-2609 r"CUtRAL � /
WOW.citgoffederalwauCOM ;it-DING DEPT.
The ollowin• is re•uired in ormation-an incom.fete a••lication will not be acce.ted. Please •rant le.ibl (in in or •e.
■ PROPERTY INFORMATION -
SITE ADDRESS 3 k s (S NJ 1 QM A- )U n.•1
ASSESSOR'S TAX/PARCEL# . S d I' r' , - O D Zo O SUITE/UNIT#
LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot I) � � 47M'el'/'4-
C✓
(Attach separate page for lengthy legal descnpNon)
i -,.• ':. ■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL -
0 DEMOLITION 0 ELECTRICAL ❑ ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlrt)
l sit FQ6, l-A-Thi c-A-& 64-\ t-V—L. I F412..::.
nl uJ D UkL -- f L, _L_ c/47- Lr4 t3 AD i7 P J ECJ
MG Di 0.14-1- a 4-s ;
PROJECT NAME(Name of Business or Owner Last Name) T. F12-14ILIG(S t+1-°C-7:'I741-- — 44 71+ L,A-Pj RE/14(),05.4_
PEOPLE INFORMATION :
PROPERTY NAME
OWNER .F./144 �G �O s�/7741-11-- PRIMARY PHONE A
MAILING ADDRESS
1 t J I (�53) �W� ,6/op
3•T s,�s 'JIM CITY,STATE,ZIP ' 1
7�-f 41J5• 5• � FPEl2 — w I WA. 7 g co3
CONTRACTOR COMPANY NAME APPLICANT NAME
OFFICE PHONE
e-u-66..1 cvlvst-/2,.4./c_Tton1 co. 'AIVIpLi SOS-n-c E(. ( 0)62Z3 - j 77c
MAILING ADDRESS CITY,STATE,ZIP
i-7-i cidc� 0 MI6
ld G CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER �Ef}-n—L D �O 1 )
EXPIRATION DATE TE FAX
FAX NUMBER
2 0-19 cy - ( o L `f' 5' -BL (?: / 31 / oS (zaro)&z3 - 5"7-0
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application
EXPIRATION DATE
APPLICANT COMPANY NAME APPLICANT NAME
Z!MM 2. Col�[�j Li i. C'}_A�4 pAgTivegsitie J0.14-k) 114e5 (ZoCr) 57-1 - 34-IC
OFFICE PHONE
MAILING ADDRESS CITY,STATE,ZIP
12c �V[71 7 Ade, tiiiy_, j -,„ CELL PHONE
RELATIONSHIP TO PROJECTFAX 7G `�'C1.v y�- , I,w���Q� ( ) -
AArchitect 0 Tenant 0 Agent ❑ Other(Describe) '[ (�/ry (Zc ,) c
CONTACT f NAME PRIMARY PHONE
An E S 5 I (.-per � .52'
' - -- 4-t
-F E-MAILL I ADDRESS�]
LENDER o �Vl Lo S 5 C/ .CI�J�I
a :� •.� ��° D �` � od � afs �� , NAME /^
MAILING ADDRESS CITY,STATE,ZIP
• .• • .. . II DETAILED BUILDING INFORMATION
EXISTING USE L4 o.p 1't*L_ PROPOSED USE 1.4.4s,a?I T 4-L
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $_•z 2 .er�iC%
SPRINKLERED BUILDING? (ilicYES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED
/REQUIRED? 0 YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE o TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
II
•
•
• . _-' PROJECT FLOOR AREAS
•
AREA DESCRIPTION EXIST.FT.ING PROPOSED TOTAL
SQSQ. FT.
BASEMENT 2 Q
FIRST �( S 1 J 7 t O
SECOND •
THIRD
•
'FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
EIQSTINo PROPOSED TOTAL TOT�ii.� • ISO SF AL PROPOSED SP 3y '3:.` SAL B "� -^y
NUMBER OF FLOORS k " 4
•
"*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(commrcial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING Y
BATHTUBS(orTuh/Shower Combo) SHOWERS WATER CLOSETS(foley /\ MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS /}�� My.��vi L ��
GAS PIPE OUTLETS SUMPS RAINWATER SYST 1:7):4,1312„)
�7 Lam[ / .
WASHING MACHINES URINALS HOSE BIBBS
LAVS(9a hroom s :) 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,incIu•Ing i s officers and employees, upon the accuracy of the information supplied to the city as a part of
this application. Al
r �/
DATE 11 �i/P�J
NAME/TITLE /
Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor
0 Architect
❑ Other
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+a W eAD®mITYO �. , t r � � 'IE �;xx ? 73,71,74%•. „,
+� [] >.LO , � �.
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Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application