04-105192 .......... RECE140
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Federal Way SEC 2 3 PERMIT - -
COMMUNITY DEVELOPMENT SERVICES 2004 SF MF �� E EL' �E EIV FP
3JJ2F 8T"AVENUE SOUTH•03 Qx F FEDERAL APPLICATION TO
FEDERAL WAY,WA 986GKI-�7�
253
m3
u5w2.6snhda'oq..co �)LDING DEPT.
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The following is required information-an incomplete ap.lication will not be accepted. Please print legibly(in ink)or type.
2 p ;; I N PROPERTY INFORMATION -
3
SITE ADDRESS 451�J -! ',lye-. gDc . .
SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# p -^ LOT SIZE (s)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) >F 4
> '•1 4C ?• CD free- s�E_-/ •
/Alto h separate page for lengthy legal des r ptioo)
.;,. , 1-z. :- • PROJECT INFORMATION .'.
TYPE OF PERMIT BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL 0 ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlq)
-r 1 lt)0,e/G . 'owe- /OAi op eXiS%i,Qc cL,Aii ,4(_ sP-fc 0 7-4yC
ri F-Ld02 CF 7?-1-6 i 1DiC4- OFr'ic€ 5U,L.D;Al61 •4T € HO5fa/tz.s
$i ?b , d-edvE orve-oc-v -,,7- 5•E4vI c. -5 4a-oc.��',.l a pe_aw► Gc do,e•
of Selma acct -DiAJ Ej. v/4le-jou$ r/AN i G44._. t cri-e- c4°G1..e.4 rJ es TV
PROJECT NAME(Name of Business or Owner Last Name) 5r`4 Al 0 a our/34-7i i SV/ o niez t o(p ' ,2//84410"•
L' .` M PEOPLE INFORMATION ,
PROPERTY NAME PRIMARY PHONE
OWNER S% F/2-74-NC-4 S H5I°/ Mit-c- (2S3)42-4. - 6g35-
MAILING ADDRESS CITY,STATE,ZIP
R-11- Sou+t, S 5-ty-e ,-C- T"-e-t7 inn t ,u.1 e4-- Gi S4O S
CONTRACTOR COMPANY NAME APPLICANT NAME
�
OFFICE PHONE
Sa .3-eA -
�Ivt� Uc�1 +�� ( )
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
- - - s L / / ( )
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
SEt c.c G * 3"3-2 N0 / /
APPLICANT COMPANY NAME
^ _1 APPLICANT NAME J��(� /�j�
1746pi Lam' 1/.JI� Vtcc-e- `g4 Z, -7 /►+ NclJ (FFICEPHONE - (6�
/ �-43.=
�j ��/ ,/� ',�A�Q /'fir{/- x.53`)q6�5S
3MA16 1 LING DD !3= •✓✓"—A1 CITY,STATE,
It+// 9g122(EL )"4 -
RELATIONSHIP TO PROJECT - FAX NUMBER
Architect 0 Tenant 0 Agent 0 Other(Describe) ( ) _
CONTACT NAMEPRIMARY PHONE E-MAIL ADDRESS
STVC• P•eNN%Al 617 Al (253) X424- 6$35 Ste✓et 14Pri ,g►
LENDER �iLfi PerRCW 19.27.095: Lender information is NAME 51._ CIA., c', G'/?rWepe:c,ii.,1)~qj0v required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
- ,■ DETAILED BUILDING INFORMATION -
EXISTING USE44-asp!?A-t__. PROPOSED USE C lS t • N O cot-(-4-14.-ti 6. .
EXISTING ASSESSED/APPRAISED VALUE $ E�g-I S I • VALUE OF PROPOSED WORK $ 380,00e2•
SPRINKLERED BUILDING? RYES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? %YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) pat-4 51-
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
•
. PROJECT PLOOiZ AREAS
AREA DESCRIPTION EXISTING SQ.FT. PR• 4 SED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD fcrs / q ._ 'ST " NU ca
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AMO PROPOSED
"NEW HOMES ONLY"* NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $_ l
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing furfures to remain.
MECHANICAL C_.•/I{-
Value of Mechanical Work $ �
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS / FANS HOODS(Commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
V COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS iorTub/Shower Combo) SHOWERS WATER CLOSETS(roUn) _ MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES
(3 LAVS(Bathroom Sinks)
ELECTRICOSE BIBBS
WATER HEATERS
i:) VACUUM BREAKERS
. 1.: 12 ra. .sem
_•_�.-�.�; .' -� .-��•�t' f �, _ =DISCI:AID�tJSIGNA'!'QREBLOCB »� , ..4.� � l.. _
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
! ZI ---(-74%-81,-1-m^-1 //'! �' rC-t t OY'DATE
NAME/TITLE / �� U �(�y//�� (g27/02-3/ /
(Signature) (Title)
I RELATIONSHIP TO PROJECT 0 Owner 0 Agent ❑ Contractor Architect 0 Other
i
f
I
4 FOR OFFICE USE ONLY
o NEW a ADDITION o ALTERATION o REPAIR d TENANT IMPROVEMENT
i BUILDING SHELL ONLY? o YES a NO BASIC PLAN? D YES a NO
i ZONING DESIGNATION CHANGE OF USE? ❑YES a NO
t NEW ADDRESS REQUIRED? a YES ❑NO UP/SEPA/SU? ❑YES a NO
PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? a YES ❑NO
Bulletin/1100-March 30,2004 - Page 2 of 4 k\Handouts-Revised\Permit Application