07-100977 R C IVE
F ` cS-2.aO7 o0077ederal Way F
PERMIT
COMMUNITY DEVELOPMENT SERVICcsOF FEDERAL WA' SF MF CO ME EL PL DE EN FP
33325 8n;AVENUE SOUTH•Po BOX sEMILpING pFs
FEDERAL WAY,WA 53-835 718 P p�,I C AT I®N �°
253835-2607•FAX 253-835-2609
At,
www.cituolfederalwau corn �� .7 (�i/
The following '
is re in ormation- n Inco tea••hcahon will not be acce.ted. Please .rint ie+ibIy(in ink)or ty.e.
• PROPERTY INFORMATION
SITE ADDRESS S 3_36 .--/-11 <1 1 ,/ /$L :. C1. �.F4 y)(L0J SUITE/ NIT#
ASSESSOR'S TAX/PARCEL# Z6- _e3- 00 - (50 Z-
/ LOT SIZE(4)LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) L.-. 2 c$ e7A 11i12V (ate r. <2/0
(Attach separate pagefor lengthy legat descrtnfinn)
a PROJECT INFORMATION
TYPE OF PERMIT ❑BUILDING ❑ PLUMBING 0 MECHANICAL
0 DEMOLITION ELECTRICAL 0 ENGINEERING . FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
L D,tiC t L' ♦ C _� yT �� G� �� <
L4211-N (-e-IO;I rl 2A(1 .L__./34.-50. r _-i LAC a)77A3CL JYI•ZcIek DST/ELi�.e5
A b o v t,/a KEI Love---- • -t+ l-9,1g-A- Di.Tee i O CIL i g- ()SE_
/ A-)r1rYZ ilri.' ti1ic 1\377,
PROJECT NAME(Name of Business or Owner Last Name) .� , LZ_ -
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER 11-1 j H(rL-i Li 5 1X LL ( ) -
MAILING ADDRESS e CITY,STATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
5m.ri (=l 'LE syr rcni, ,nn ti.)► — 4 �% Pett,-(LeF �2c3) ?Lig -ZCOL/
MAILING ADDRESS CITY,STATE.ZIP CELL PHONE
1C?1t SL//h NUt _ /- ' T %Atc,r i41 Lc'4 ` jjztl ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
L. -2 r7-1`12- c c B L l2 /3 ( / o8 (7.5-3) 92e- rIZ
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
5. vvi L "% 1 _ S 91 ( L C3 1 Z / 2 Z_. '08
APPLICANT COMPANY NAME APPLICANT NAME -
• OFFICE PHONE ryI rl► r.I Octi _`x�5 6 r)')4ASC,. 124.196- [- .Fath_ (75,j ) Z%'8 -2_e6;74/
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
t l oU �L/>� I � (,_ _ /a I Aee r r+ g4►Zz1 c
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent 'ether(Describe) F42e AL A(ZrV' ( 2-53) 92 072
CONTACT NAME PRIMARY PHONE
�� - E-MAIL ADDRESS
(25 ) 2Z�( ZEX3 z L m_e e9r
LENDER ` ;Si-�t�i�)�e ALL_C t
k ''2 �r NAME
MAILING ADDRESS CITY.STATE.ZIP
DETAILED BUILDING INFORMATION
EXISTING USE e iJ) . •( L_ PROPOSED USE J"=}LCC 1,4. i1v 1 i\r 7i'PAD
EXISTING ASSESSED/APPRAISED VALUE $ -' �""'/ l7o C VALUE OF PROPOSED WORK $ '/1 300, -—
SPRINKLERED BUILDING? ❑ YESNO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
•
f
;;4) PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST /��7 �y
SECOND �, G I l!(i Z_ivZ 7 C'
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE O CARPORT 0
EXISTING PROPOSED TOTAL e3..
NUMBER OF FLOORS t 6 Tasat u a
**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(commeretan 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 iTo,kU MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAYS(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 ielia {2 DATE 2" _ Z z 2 9
(Signa[ -)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent ❑ Contractor ❑ Architect Other F!i- 44-4442 yr\
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Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application