07-100233 F ECEIV •
��,� .1 7 - 1 0 0 2' _3_.7
Federal Way PERMIT
COMMUNITY DEVELOPMENT SERVJC
IAN 1 6 Z3.J i SF MF CO ME EL PL DE EN
33325 8TM AVENUE SOUTH•PO BOX 9718 ►'Vp LI CATI O N
"RAcwAr,wA 9538° p7„t,OF FEDER
253-8352607•FAX 253 83 Y
irD
www.atuofederatwawcom BUILDING DEPT.
1.
The following is required Information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRES- /'h I'i _ ':f,7 , I, SUITE/UNIT#
ASSESSOR'S T. '/PARCEL# I (P _ 0- 00 i , co LOT SIZE(s,J)
LEGAL DESC• r ON(e.g.Acme Estates.Lot 1)
`-?.- ` Rath se••A t,, de.
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 'LUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
C)..14-1 CC_ri Li 1.1 1 c....
PROJECT NAME(Name of Business or Owner Last Name) C 1\0\%U...." .. VAiJbe"1/FIN t-
• PEOPLE INFORMATION
OWNER
PROPERTY k kV fi nee' e�-p I-o\ Y\, ) , L -C i Y PHONE -k:.75�^[
�,IN RFCc C ST TE,ZIP '�/J�/�'� Y
t F'As/'� �y` .- 1 .5 E-MAIL ADDRES
7146\-1
CONTRACTOR 1\�D��ARY NAME"IV n APPLICANT NAME OFFICE PHONE
1 H' go�soct4A soc--:5-ko fi.� (42S) %21 -.T33o
IN ADDRESS CITY.STATE IP CELL PHONE
M14S � 0E i�4b fir, rd � >a\ ) (If ) g` - 2
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
(125)%, - 5
CONTRACTOR'S REGISTRATION NUMBER
COPY of card required EXPIRATION DATE E-MAIL ADDRESS
..�. => ip3 S C *. CY ,c %U s- + `Is e f i,e ticA,So 1.-1C,P.r OM
APPLICANT crILMANYV MAMA' APPLI S l E /� L�/� OFFICE PHONE
T(1C-t-DV ,o`f�-"C? Crikpswi. , ( . )
MAILING ADDRESS 1 ..• CITY STATE. Peng„y) i - N Z&..
RELATIONSHIP TO PROJECT / FA NUMBER
0 Architect o Tenant ❑Agent xrOther C..014111 -00—...P ( ) -
PROJECTE //�� PRIMARY PHONE E-MAIL ADDRESS
CONTACT DOJ Hi4rp-iC�'_Sc t3 (1{ 1.) �- cOO
LENDER NAME � 10 1.3A Q.,, 135 a�N i i NIL
Per RCW 19.27.095: l.3 i 1-FaL';!s I Caa1
Lender information is required(f project value exceeds$5,000
MAILING ADDRESS CITY,STATE.ZIP PHONE
( ) -
i• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ W 900
SPRINKLERED BUILDING? ❑YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES o NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER Cl LAKEHAVEN Cl HIGHLINE 0 PRIVATE(SEPTIC)
""40 U PROJECT FLOOR AREAS x'�.,�►
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS ZEM>ro room TOTAL TOTAL zawumO SF TOTAL PROPOSED SF TOTAL ST
**NEW HOMES ONLY NUMBER OF BEDROOMS' ESTIMATED SELLING PRICE $
zf
• FIXTURES
Indicate number of each type of%ture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $ COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS E ORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS �, GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS)Commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG S REFRIG.SYSTEMS
•
PLUMBING
BATHTUBS)or7Lb/Shower Combo) ' VS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS _ -'._ RAINWATER SYST VACUUM BREAKERS 09103
DRINKING FOUNTAINSSHOWERS WATER CLOSETS mode)
ELECTRIC WATER HEATE: SINKS WASHING MACHINES 2, R p r3D S
HOSE BIBBS SUMPS
SIGNATURE
I certify un• r • • alty of perjury that the _r orm• 'n furnished by me is true and correct to the best of my knowledge,and further, that I
am authorized the owner of the abo p es o • rform the work for which the permit application is made. I further agree to hold
harmless the Ci . of F • ral Way as • f l •Ing costs,expenses,and attorneys'fees incurred in the investigation and defense of
such claim),wh ch may • made by • _ nc .1 >• the undersigned,and filed against the City of Federal Way,but only where such claim
arises out of the relian- of the ci , , is fc rs and employees,upon the accuracy of the Information supplied to the city as a part of
this application
NAME/TITLE T tkps t.._ DATE l IQ )07
(S: alum (Title)
RELATIONSHIP TO OJE 0 Owner o Agent Contractor ❑Architect ❑ Other
a NEW a ADDITION o ALTERATION a REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES o NO BASIC PLAN? a YES o NO
ZONING DESIGNATION CHANGE OF USE? a YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES o NO
Bulletin#100—January I,2007 Page 2 of 4 k\Handouts\Permit Application