06-100065 ‘Trof REc• r (o - / 0 0 0 &
Federal Way PERMIT - -
CO*UNITY DEVELOPMENT SERVICES ;f< 0 6 2006SF MF CO ME EL PL DE E FP
33325 FEDERAAVENUE SOA 98063 BOX 718 APPLICATION TD
FEDERAL 07Y,FAX
93063-260
253-835-2607•FAX253-835-2609 CITY OF r EDERA /
www.cittioffederalway.com BUILDING L VV��^"
'
EPT.
The ollowin• is re•uired in ormation-an incom•lete a••lication will not be acce•ted. Please •rint le•ibl in ink or •e.
■ PROPERTY INFORMATION
SITE ADDRESS 335'3.5/ E/t;HTH Ap' /So! Tx/ /� SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 9' c 62 5 v I/! - O ( v LOT SIZE (s4)
LEGAL DESCRIPTION (e.g.Acme Estates, Lot 1)
(Attach separate page for lengthy legal descripoon)
■ PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING .FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only()
ADO A i/Re SPR/L k[.l , S VS r /4 lb A "re, STINg ' £31/.../414
PROJECT NAME(Name of Business or Owner Last Name) q -4 /4 ♦l v II 1 t51 •
■ PEOPLE INFORMATION
PROPERTY NAMEcJ PRIMARY PHONE
OWNER g L k- - 622,6,)4o (/ -6 7-oo
MAILING ADDRESS CITY,STATE,ZIP/
(COO (.{ 1titVe.US; 5�• l,rir Seaale c'/O
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
F//?E 5ySrrit.4 weST' G24/4 it-t/4-4E-At (2s3 )633 -/2`/S
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
2/9 , ,4ovT44e Ru vi" 418 PActfi/c, t,A1 fees/7 ( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
i 9 - e'7 - o o o Q / 9- B L 2 /3/ /etc (25',3 ) 73r. 0//3
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
/ i2 r y o 13 L l l
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
rirl� SrSrE- s ‘1-11‘57-
MAILING
i1i rMAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
D Architect 0 Tenant Agent 0 Other (Describe) ( )
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
C ?4i4 "-1/ el (2S3 )X33 -/zys
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
■ DETAILED BUILDING INFORMATION
EXISTING USE OA'N"'/GLS PROPOSED USE O,C" /GG•'" !y
EXISTING ASSESSED/APPRAISED VALUE $ ___ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES NO NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? )(YES 0 NO
WATER SERVICE PROVIDER ,k LAKEHAVEN HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN n HIGHLINE LI PRIVATE(SEPTIC)
OS--/06(( (o
i i
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ. FT. SQ. FT.
BASEMENT
FIRST
SECOND
c7/C.4? - S Ne'4-� 5P44e' / �c O �1 7 s'vu
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each.
h type of facture to be installed or relocated as part of this project. Do not
- ude existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(comment.)) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OU TS
PLUMBING
BATHTUBS(or Tub/Shower Combo) = OWERS WATER CLOSETS(Toilet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
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.
NAME/TITLE /!o�'L�T /t-1/ 4 DATE
Ignature) (Title)
RELATIONSHIP TO PROJECT 0 Owner ❑ AgentContractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
❑ NEW ❑ADDITION o ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION CHANGE OF USE? ❑YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? ❑YES o NO
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application