06-101003 „ tt
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z. Federal Way
MAN 0 z 2006 PERMIT SF MF CO ME EL PL DE E P
COMMUNITY DEVELOPMENT SERVICES
33325 8”AVENUE •PO BOX 9718 L I C AT I O N
FEDERAL WAV,,WA
9 98063-9718 Gi OFED� � /
/
23-835-2607•FAXX A 253-035-2609 f�
www.cittioffederalway.com Q1l!LI?IN®DEPT,
"yW►��
The ollowi • is re•uired in ormation-an Inco •tete a••lication will not be acce•ted. Please •rint le•ibi in i or
■ PROPERTY INFORMATION
SITE ADDRESS 4 3 20-114
ca
4° g SUITE/UNIT#
ASSESSOR'S T v *( 2 t - 0 8-
LOT SIZE(4)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal desoip ion)
-
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 1,12tIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
5105-Ili ,L i'414,3 w 1 T 1_1�6 g it,w, ,G.,P__ Sm s-rsK Foie_ ec(cor1
-Cv(c c)(t t j'- Nit' ficA-M t-ri o
PROJECT NAME(Name of Business or Owner Last Name)r(O K IP - $((4- 61-7-SAK A"'1 v St✓
Is PEOPLE INFORMATION
PROPERTY NAME, / iy l / PRIMARY PHONE
OWNER rt 0 N i(xD ( •�
MAILING ADDRESS I ` ZS�) P/Y le33 Z
CITY,STATE,ZIP
I O-2_- Pr- WooOwlr DR Ne retcok-t e,'r4- nfY 22-
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Eger N46(414)04 (21-3) 8210 -605�•t 1
MAILING AD RESS CITY,STATE,ZIP - CELL PHONE P�! • f g4
1014 140 1 6,1.' �(,i 71-- 20*- SvMN61z t' t CleS 0 (4'5 ) 310 -3044
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
2 0 -O -1 0 0 (Q 3 a-8 L 1-2. / 3 I /soot, (24)3 )6'240 - )0 33
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application)
l E1-- EXPIRATION TDATE
(
p? 12• 11 soot,
APPLICANT CO,
(T
MPANCOMPANYNAME APPLICANT NAME ... OFFICE PHONE �r-�•�
MAILING A DRESS J�\D"t�r 14)41121
"{561J (2(3 ) �CO -Wq9
CITY,STATE,ZIP CELL PHONE
10(4 NSHIP°�TO PRELATIO � t)iv. 2a L 3 4 - i'�: o (21-, )370 :5044-
ECT
FAX NUMBER
0 Architect 0 Tenant o Agent Other(Describe)Ct'nw -ro,p, ( ) 8740 - /6 372
CONTACT I 4AME
PRIMARY PHONE �� ( E-MAIL ADDRESS I
tz?T` Vlatzg(Sa� I W-5 ) 62lp -
LENDER , ' . ?• a s� NAME
MAILING ADDRESS �` -/ V wArt�
CITY,STATE,ZI
■ DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
`-�`EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ '5 4 tai
SSPRINKLERED BUILDING? 1ES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 1r -_ 0 NO
WATER SERVICE PROVIDERLAKEIIAVEN 0 HIGHLINE ❑TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAKEHAVEN 0 HIGHLINE a PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION 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 TOTAL7°` 8r�y toTlt PROPOSED SF xont[sr
ZXSTpr6v .. . .. s. ,
*NEW HOMES ONLY** NUMBER OF e DROOMS 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.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIV 6 COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(co. WOODSTOVES
BOILERS FIREPLACE INSE• S MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOW".•S ATER CLOSETS lroikt) MISC(Describe)
DISHWASHERS —�`
SfNKS D' • ING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWA R 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 ance of he city,including its officers and employees,upon the accuracy of the information supplied to the city as a part of
this applicatio
NAME/TITLE taAe /4,6,51 DATE Z` J/Oc.o
(Signatu (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent contractor 0 Architect 0 Other
4'7 ,ice.
w 'AD•I IO � LTERATION ri REPAIR .<r EN � ROXTEMENT z= d ;,M.,�' �±
a ,
e ��D ®$L { �NOf c BASIC0PLAN?`WW70#73.Flit4,j ;OYESi`ONO
G •ESIGNATION a CHANGE OF USED agto YES 4ta
IEW ,DRESS REQUIRED? yfl r$o NO g r UP/SEPA/SU?Aa,94* _❑YES000.- i £
ED �.T - NO DEMQ.PERMIT7QUIRED? x b YES,e a °pkv t t
11 1 Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application
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