06-101288 illor
RECEIVE O—(0
CITY OF _Za / / ,Federal Way `ry,� PERMIT r /�
COMMUNITY DEVELOPMENTSERVICM AR 1 7 200F SF MF CO ME EL PL DE E P
33325 8Dt AVENUE SOUTH•PO BOX 9718 yP LI CATI O N TD
f- /
FEDERAL WAY WA 98063/�j� f�D�n a.
253-835-2607•FAX 253-83s.ee r
OF
wunc.citi/olfederalwaL.corn BUILDING DEPT.
The ollowin• is re•uired i ormation-an incomplete ap•lication will not be accepted. •lease •rint legibly(in ink)or type.
('� L • PROPERTY INFORMATION
SITE ADDRESS
3._ y3(,/ ,P ✓r t,f ,-�(G�C11/ / �y SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# / ,>2 {j `J 0 / - 6 / 6 LOT SIZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page Jor Lengthg Legal descrip(ion5
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJEC DES RIPTION (Providelietailed description of work included on this permit onlil)
ha o' ,O...44.11 /1'' cytZ-,n ,syjf� 9 . �� ,/i /.1 f
lri Ur? ,be-f 1r% ,5R0(4)(fail , /c.c/-% ‘. ( 4.itt:/n ) '1 /Acta//."A , n. vec/s,r), ) 4iei-rm (90c rt✓nrn;/), q Ms�S.��t1, v d`
PROJECT NAME(Name of Business or Owner Last Name) 9 `4 Vi- P 'V /(/On
I • PEOPLE INFORMATION
PROPERTY NAME l 1,[ i PRIMARY PHONE 7�t
OWNER r� 2, e Pd6 ) y e7e6/ -
M LING ADDRESS ,STATE,ZIP
Ll/,►,w�/�/ Sf 45/5,
sfs , a 4, (L)4 MO
CONTRACTOR COMPANY}AANAME
//?NA E APPLICANT NAME OFFICE PHONE
'i � iADDRESS C t(t'C CITY,STATE,ZIP CIVdPHONd'/y -Csa
/).1/4 /J //( Cf JLJ ifeako� CA 9,0r) ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
6- -L Ga V' 7 . B L / - /JG ( ) -
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
,. e0QD E- C9775 g / /,9 /a.7
APPLICANT CVIPANY NAME APPLICANT NAME - OFFICE PHONE
Pie c/5/61 l/e2rin /a L1 / aws4 wow)497 -6v/4
MAILING ADDRESS CITY STATE,ZIP CELL PHONE
96630 561i .mac 6) f/y 4yymwav L)/3 /3� ( o�)753 - ,3eFs-
RELATIONSHIP TO PROJECT FAX NUMBER
o Architect ❑ Tenant o Agent ❑ Other(Describe) ( ) -
CONTACT NAME PrRIIMARY PHOONE E-MAI DRESS
a7775..g
LENDER `pel Reye',I9 27 095• Lender information is NAME Com,,
required(fproject value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ (/
') K
SPRINKLERED BUILDING? ❑ YES C NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? n YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
IsI4 W
mh
if • •
PROJECT FLOOR AREAS
AREA DESCRIPTION 1 EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS
EXISTING PROPOSED TOTAL TOTALWSTISO SF TOTAL PROPOSFD:SF rorAi SF
**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
PLUMBING
BATHTUBS or Tub/Shower Combo) SHOWERS WATER CLOSETS moot) 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. r,
":q,,
NAME/TITLE i;#l DATE �//7%6
i (Title)
71
RELATIONSHIP TO PROJECT 0 Owner 0 Agent ontractor 0 Architect ❑ Other
FOR OFFICE XSNaNLY
n NEW i ADDITION ❑ALTERATION ❑REPAIR 7 TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? 3 YES o NO
ZONING DESIGNATION CHANGE OF USE? -1 YES n NO
NEW ADDRESS REQUIRED? c YES ii NO UP/SEPA/SU? ,a YES ❑NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100-January 1,2006 Page 2 of 4 k\Handouts\Permit Application