04-101306 P
• RIVED cps
COMMUNITY DEVELOPMENT SERVICES
O O 33530 FIRST WAY SOUTH•PO BOX 9718
uri �, R FEDERAL WAY,WA 98063-9718
Way PERMIT APPLI CAT O N 253-661-4115•FAX:253-661-4129
www rauotlederalwau.corn
•Federal OF FEDERAL WA'
1 1 I') } ,�..z Era:
For Once Use Oaty. J / j 1 I ',- ° �-
FW File Number: - tL �- — i /
The ollowin• is •wired in ormation-an incom•tete a••lication will not be acce•ted. Please •tint le•ibl in in or •-.
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• PROPERTY INFORMATION
SITE ADDRESS: 3 Ll-�j 4 5 g P'' . t A-f-V\ F Wal vo6\-- SUITE/APT#
ASSESSOR'S TAX/PARCEL#: -7 S 0 1 I
5 - 0 0 '2-0 SQUARE FOOTAGE OF LOT: l� OZ)
LEGAL DESCRIPTION(e.g.:Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT(This application): ?BUILDING ?PLUMBING ?MECHANICAL ? DEMOLITION
?ELECTRICAL ?ENGINEERING(? FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlii):
A olct Oy\ i-D -A-re A 1c t-vY.. S LiscDrvi •
PROJECT NAME(Name of Business/Owner Last Name): cJ - I" v0-VA 5 5e'l 1 G 1--41)f L--4r0e e_0'bv'-"(..
• PEOPLE INFORMATION
PROPERTY NAME: PRIMARY PHONE:
OWNER: rfa-V1C}1/4.5(.,V-• �--� l`v` J li'J�QiV-v/1 (15%) �7 I - ui-3 ci
41111 MAILING ADDRESS(STREET ADD ESS;):` CITY,STATE,ZIP
1 1 ; c�u LL S 3Y`i - -"a c_CN.r‘.ck.-_, 1.),--=rA q 5 LI-0 c7
CONTRACTOR: NAME gOMPANY OFFICE PHONE:
Jn�c c� E e-t>ri G C.n Ibtuc U. ( 2014) 4-3k 5 o
MAILING DRESS' ADDRESS;): T ` CELL PHONE:
15 1-1"'I -} r'"
" i+V C Set_t e Lc ft (1" !Da ( '.61p) c<Sb -759 ?�
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: EXPIRATION DATE: FAX NUMBER:
- - - / / ( . 11`f'�yl) LJ� - O C;-7
CONTRACTORS REGISTRATION NUMBER: EXPIRATION DATE:
(copy or card required with each ipplication)�� `� )C) / ( / 2-C-/--
LENDER:
-""LENDER: NAME: .� DAYTIME PHONE:
(If Proposed Value>105,0001 1`-_"i f--- . ( ) -
MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP
Of APPLICANT: NAME COMPANY OFFICE PHONE:
(1
,K(1 4-k; L vk r—� 't to � ��Vt V1-V�t (t 1(i- ) 1'11 - I`f 1,-`v"
MAILING ADDRESS(STREET ADD ): CITY,STATE,ZIP EVENING PHONE:
9510 1( '1` FVC) `OLIu. - 1 av S1cc* ICttIC Loft q b l O ( ) -
RELATIONSHIP TO PROJECT: FAX NUMBER:
?Architect ? Tenant ? Other(Describe): A-i wit HoLo )ZCt) - 6i-t,
CONTACT PERSON FOR THIS PROJECT: ?Property Owner ?Contractor ?Applicant'' E-MAIL ADDRESS:
■ DETAILED BUILDING INFORMATION
EXISTING USE: PROPOSED USE:
['�Z�
• EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $ ii-CO `
SPRINKLERED BUILDING? ?YES ? NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: ?YES ? NO
WATER SERVICE PROVIDER: ? LAKEHAVEN ?HIGHLINE ? TACOMA ?PRIVATE(WELL)
SEWER SERVICE PROVIDER: ? LAKEHAVEN ?HIGHLINE ? PRIVATE(SEPTIC)
III
■ PROJECT FLOOR AREAS
4110 AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
**NEW HOMES ONLY** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ FIXTURES
Indicate number of each type of fixture that is 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(commeroia) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
0 PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS(Toile) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYS
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sink 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.
J� A l Zit)NAME/TITLE: �' I "�t '� ' ' ' DATE: ` '
(Signature) (ritie)
RELATIONSHIP TO PROJECT: ? Property Owner ? Applicant ? Contractor ? Architect ?
FOR OFFICE USE ONLY:
?NEW ?ADDITION ?ALTERATION ?REPAIR ?TENANT IMPROVEMENT
BUILDING SHELL ONLY? ?YES ?NO BASIC PLAN? ?YES ?NO
ZONING DESIGNATION: CHANGE OF USE? ?YES ?NO
NEW ADDRESS REQUIRED? ?YES ?NO UP/SEPA/SU? ?YES ?NO
• PLATTED LOT? ?YES ?NO DEMO PERMIT REQUIRED? ?YES ?NO
Bulletin#100—January 13,2004 Page 2 of 4 k:\I-Iandouts—Revised\Pennit Application