04-102887 ili
a o RECEIVEE- Z 5 7
Federal Way -� � -
PERMIT SF MF CO ME E DE EN FP
3530 FIRST DEVELOPMENT SBO7 2 1 2004
33530 DIR A WAY SOUTH• 6 -9 p p LI CATION iii///
FEDERAL WAY,FAX
98063-9 1,2 TD / /
253-661-4115.FAX 253b6 ]
www.dtganederarwl<,;.6� �F FEDERAL VP
7P
DEPT.
The ollowin• is re.uired in ormation-an inco •lete a.•lication will not be acce•ted. Please •rint le•ibi (in ink)or .-.
�) {,., PROPERTY INFORMATION •
y
SITE ADDRESS J 1 2 6 `f ' '(/� r\) SUITE/UNIT# )"1 kV
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal desmptron)
PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permitonlu)
/ J' , i f--7- 4,,ii,s i i , Ahb )5/4- -,'-r
PROJECT NAME(Name of Business o Owner -rst Name) c//14 LL._
PEOPLE INFORMATION
PROPERTY NAME
PRIMARY PHONE
OWNER >i a+ �' rc'1
MAILING ADDRESS Gn � L�� ���� ,Y 741
` -/� �
i
CITY,STATE,ZIP
1 S 4 �N .4'r/d PO PtisD 2_/4.. i.L.4 wA
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMB ER
_ _ B L / / ( )
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application( EXPIRATION DATE
/ /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
Q (Cr?CPT-4 ( ) y 71? -I a:S6
MAILING ADDRESS CITY,STATE,ZI CELL PHONE
31 S2 0 i S ) P: 14/42, w/, / �' )
-
'.c
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑ Tenant o Agent I<Other (Describe) el,F ( ) -
CONTACT NAME PRIMARY PHONE
E-MAIL ADDRESS
1
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000 k ) ,)11}‘0-‘ ---
MAILING ADDRESS CITY,STATE,ZIP ,`/ U
• DETAILED BUILDING INFORMATION
EXISTING USE f,/',/4 t;,/ /:-.6te4.'1 L !//f1 PROPOSED USE r//1/62 L_E; 4—,./90-34 J,,.L3
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES 'NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES )(NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE TIC)
•
PROJECT FLOOR AREAS •
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 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(Commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PUTTING
t BATHTUBS(o,Tun/Shower Combo) SHOWERS / WATER CLOSETS(Toilet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
' I LAVS(Bathroom Sinks) 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. ^{
\\1 / Z I
1
NAME/TITLE -7L) DATE
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner ❑ Agent ❑ Contractor ❑ Architect 0 Other
FOR OFFICE USE ONLY
a NEW a ADDITION a ALTERATION o REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES o NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION CHANGE OF USE? a YES o NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? o YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—March 30,2004 Page 2 of 4 k\Handouts—Revised\Permit Application