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, ," I COMMUNITY DE I ELOPMENr SERV/CES
�/� \�G�,� 33530 FIRST WAY SOUTH•PO BOX 9718
cm,O . — FEDERAL WAY,WA 98063-9718
Federal Way PERMIT APPLICATION 253-6614115•FAX:253-6614129
wwwcityotrederalu w mm
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Aoki For Office Use Only: _ -
FW File Number: -7 —
_ _
11. Y OF FEDER
The oliowin. is re. •c,, bw1.L ;L•.`cTin-an incom•lete a..lication will not be acre•ted. Please 'Hat le.ibl (in ink)or .e.
■ PROPERTY INFORMATION ORMATION
1 J\`
SITE ADDRESS: ✓ L J \ J S. 'fi \ \ ) \N SUITE/APT # , \‘(.
ASSESSOR'S TAX/PARCEL#: 1 50 4.5% - 0 a a 0 SQUARE FOOTAGE OF LOT: N 1 c
LEGAL DESCRIPTION (e.g.:Acme Estates, Lot 1) N I A 111
(Attach separate page for lengthy legal description)
.' • PROJECT INFORMATION
TYPE OF PERMIT(This application): 0 BUILDING 0 PLUMBING • ECHANICAL ❑ DEMOLITION
0 ELECTRICAL ❑ ENGINEERIN 11 RE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only):
_ A C-Cd UWO 'X'
PROJECT NAME(Name of Business/Owner Last Name): \, . g( .. & ' LAS'' l gi:
- ■ `PEOPLE INFORMATION
PROPERTY NAME:
n t PRIMARY PHONE:
OWNER: � 11G �\� � rY-I ( )
MAIL G ADDRESS(BYRE T ADD ESS;): C S ATE,ZIP
•
CONTRACTOR NA /° t . I COMPANY \ ,. OFFICE PHONE:
O {.\Ok �?i X1 ..;-re- dire 'rt e tMaili CfaCk- D
mnu,lrvG ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP CELL PHONE:
, -1O1. 1040 E. f ora+ A- ( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: EXPIRATION DATE: FAX NUMBER:
i -OA V-1 (1 V_ q $ K-oo i )L l)./31 /oS (at:33 )a3- -Lg.k
CONTRACTOR'S REGISTRATION NUMBER: (�� (�` EXPIRATION DATE:
(copy of card required with each application) ) A T 2- 1 E P o 1 (l E / /
LENDER NAME: DAYTIME PHONE:
(If Propos<d Value>$5,0001 ( ) -
MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP
APPLICANT: E: COMPANY `yC, OFFICE PHONE:
MAIL NG ADDRESS(STREET ADDRESS): CITY, ATE,ZIP EVENING PHONE:
alb �1C)' P• F . '1acovma,VON- qS�a l ( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ Architect ❑ Tenant Other(Describe): gib . ( )))q3, -Lit°
CONTACT PERSON FOR THIS PROJECT: 0 Property Owner ❑ Contractor (%Applicant E-MAIL ADDRESS:
• DETAILED BUILDING INFORMATION
elEXISTING USE: PAZOTCAA- 6 C-4r-e.g.' 9,11>,a�(... PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $ .25-0C)
SPRINKLERED BUILDING? YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
IP
■ PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ. FT. TOTAL
BASEMENT
FIRST
SECOND •
THIRD Z )C6C00
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: $
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(commrcial) W OODSTOV ES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS(rout) 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.
NAME/TITLE: , ' t �� at i i lei i'tli II • •• DATE:(Title)
�-\ Cli 05
RELATIONSHIP TO PROJ, T:I 0 Property Owner 0 Applicant ❑ Contractor 0 Architect A AA
MC\-\,e` '
trAt
FOR OFFICE USE ONLY:
a NEW ❑ADDITION a ALTERATION o REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a YES a NO
ZONING DESIGNATION: CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YFS a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO I
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