06-102545 RECEIV • //J fff /J�
CITY OF A l �/
_.
5
Federal way PERMIT SF MF CO ME EL PL DE EN P
COMMUNITY DEVELOPMENT SERVICER'AY 1 9 2 0 06
3332E D AVENUE SOUTH•PO 9 9718 pLI CATI ON
FEDERAL WAY,WA 98063-9718 TD
253-835-2607•FAX 253-83 (19Y OF FED+Et�R Y
www.cituoflederalwau.com BUILDING DEPT.
The ollowin. is re•uired in ormation-an incom.lete a..lication will not be acce•ted. Please .rint le•ib/ (in ink)or t .•.
• PROPERTY INFORMATION
SITE ADDRESS 33+3 4— ST" AV EL)u Sc-)A-T1-1 SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 9 Z S O 1 - O I Z Q LOT SIZE(s, /O Zt 55 30 SF 4/-
LEGAL
/
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) S€ .4 TTA-C64-8V
2
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING 16 FIRE PREVENTION SYSTEM
lv l✓tee PQo i eOrtoN SY$' 1-1 iwow 3ie es/2.0,4►DO StAel't-Y
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
INSTAu-.A-T/o .i ex re— to(2 ro Tic' f6'uic U/A.)[..., //Ze- 5�2rJ/cam? PU'fltG F. 01-1 (.b(c.-CµiLuct
00N13�C' OeTeZ`TOl2, G a(-eZ Ic. VALVE fa•SS E3�iiit,-Y ✓,Q -t,c.T Y 0 A Po I►->Y Ell)e.,-- r€T FlZOU1
1 f1 FAL= OF Th c X/ST/NC) en)/c-O/Nt . IUS7i4 LGA-?7ot ' „vcLuQ5 77.I r2, I. v. ANO F a c,
AoN(a WI Th' /i{020X/o%.4 ZY Z./Alt-4747Z ,C ?-? of 5/�C //UC-14 /J/i9-'�!e-TGs72 1Q/%Gv.
PROJECT NAME(Name of Business or Owner Last Name) 9 7. 1,4126-1(-)61 G s A(//Ll p J
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER /M4PZl�- w -0 (iY'� A�/.cX,l eA,2T-Aide) 8 r/+� 9 7NL LC (Z06) 404 —6700
MAILING ADDRESS CITY,STATE,ZIP
Joao u.U/v&mss/T5- 57, Su/rE/S/5 S e9T7ze / 4'4 /O/
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
7'AG(,.s(/2.T CONSTieu.CTION / 1 A,IC O L I VEIZ. & r'1 (ZO( ) 4704 -OZS4
5
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
18633 )3T" D2 SC t3011-ke LL-, WA/%30I2 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
— B L / / (42S ) 4oZ -8412
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
7 A 6 A c 1 0 L 5 K 3 / 00 /ZOo$
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
/-II&I NRI4.I+bl..002 &SOWN reS L-c —1cArk J , Ge)e_erf (4Z$) z5e - Z8ZG
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
/7Z 1 / A-), 7T 6WENu6 Suint 401 ell&rleir CSA- 98Zo 1 ( _ ) - - —
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent XOther(Describe)C/VIt- E7VCr/Nt3ZTL (4ZS ) ZS Z -555
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
_Soh✓\ -- . %•- ed (4,z5 ) ZSZ - ZSz k. .ywrxo i-tic„n.2S ,CoYfl
LENDER Per RCW 19.27.0 . er information is NAME
required if project value excl'ds$5,000 meq/
MAILING ADDRESS - I',S • A. PHONE
/ ' ( )
• DETAILED BUILDING INFORMATION
EXISTING USE ✓At1UT "O1P/L e 01114-0/A1C, PROPOSED USE DrF/CC /jyt iec*c.
EXISTING ASSESSED/APPRAISED VALUE $ A/A VALUE OF PROPOSED WORK $ v/A
SPRINKLERED BUILDING? ❑ YES 13,.NO FIRE SUPPRESSION SYSTEM PROPOSE 0 REQUIRED? GS YES 0 NO
S )(3.ct N oT
WATER SERVICE PROVIDER -1LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL) Q�a•QuI12e•Y,J
SEWER SERVICE PROVIDER fpa LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
• •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT `,.,,,
FIRST A
SECOND G��Y/
THIRD4
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGEi ❑ CARPORT Li
N V MBER OF FLVORV 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 type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANI '.-
Value of Mechanic.. Work $
AIR HANDLING UN EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commercial) WOODSTOVES
BOILERS FIRE�� �I S RANGES MISC(Describe)
COMPRESSORS FU GAS WATER HEATERS
DUCTS G ALiTS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS 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 :'CTRIC 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. y
NAME/TITLE;' 2 /�� ..tiGa�( /+�la)1rt7 aii d=:/t t'1r12 DATE / CU
(S ature (Title)
RELATIONS O PR CT a Owner a Agent o Contractor 0 Architect c t Other elavZ 5L ,/ ' ? _
FOR OFFICE USE ONLY
H NEW c ADDITION H ALTERATION ❑REPAIR i TENANT IMPROVEMENT
BUILDING SHELL ONLY? H YES o NO BASIC PLAN? 0 YES o NO
ZONING DESIGNATION CHANGE OF USE? ❑YES o NO
NEW ADDRESS REQUIRED? YES o NO UP/SEPA/SU? ❑YES c NO
PLATTED LOT? ❑YES c NO DEMO PERMIT REQUIRED? ❑YES o NO
Bulletin#100—January 1,2006 Page 2 of 4 k\Handouts\Permit Application