04-103546 •
•
Of RECEIVED
' _
Federal Way P 02nPERMIT -� i1 __ _.c..-__q.X0
COMMUNITY DEVELOPMENT SERVICES SE SF , F CO ME EL PL DE EN FP
33530EDR A WAY,WA •98 P 3-9718BOX 18 APPLICATION
FEDERAL WAY,WA 98063-9718 • / /
253-6614 - 02
115•FAX 253-661-4129
www.anoffederalwaq.corn ( r �� /�N` FE
(E V
,66C
The ollowin. is re•uired th rrrna on-art innccoo •lea • icationn will t be acce•ted. Please .tint
le•ibl (in ink)or .•.
PROPERTY INFORMATION
SITE ADDRESS „""' ..- SUITE/UNIT#
ASSESSOR'S TAX/PARCEL - LOT SIZE(s.1)LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of wok included on this permit only)
Wt?l-1 1? v' 5 Zoom.. p.Rwe AvrAc P �'y�Qf L
PROJECT NAME(Name of Business or Owner Last Name) 29( ASK--
PEOPLE INFORMATION
PROPERTY NAME
u )) C... /PR�I,M,A�RY PH�O/N�E� �1OWNER G ' C ret (2o )Z4 -2471
MAILING ADDRESS CITY,STATE,ZIP
1o5/61 SeVrI4C€Krreg. &VD TICWIUy WA. 95I8' .
CONTRACTOR COMPANY NAME APPLICANT NAME t OFFICE PHONE
& Eitee0oess)NG R-r SE-4E4• (2 )248 -241)
MAILINGADDRESSKCITY,STATE,ZIP
CELL PHO
NE65/ '/'{ /� VTEQ )3L`rD -rV�tt' 4 ,wve9818Q (20(- )z48
-241 )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER 'EXPIRATION DATE
11_-/ e1-10 —/ G z zi- B L JZ / 30 /oaf (2oJ)2yz -4zai
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
5G H Ls1 G Sy .6 1 5_ F C1 / /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
.�!IJEWe . go"ie s l uG reiciC. Zi—r & (26)248 -241 I
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
6510 SIournceN-ren,&4'D TOK wIM WA.oi8488 (zap )24 - 3f)
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent 0 Other(Describe) (21)‘ )242_ -4241
CONTACT NAME PRIMARY PHONE
E-MAIL ADDRESS
'fl•LI C.k 71Tr g- (2e0 ) 244 -2241 1 PAIRIGKeTet zee How
LENDER Per RCW 19.27.095: Lender information is '. NAME toi
required if project value exceeds$5,000" ' NG0-6
MAILING ADDRESS CITY,STATE,ZIP
^^ DETAILED BUILDING INFORMATION .
EXISTING USE ti/A PROPOSED USE `j .
EXISTING ASSESSED/APPRAISED VALUE $ 0.00 VALUE OF PROPOSED WORK $ 220;000
SPRINKLERED BUILDING? \ 0 YES NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES NO
WATER SERVICE PROVIDER LAKEHAVEN 0 HIGHLINE o TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER LAKEHAVEN ❑ HIGHLINE o PRIVATE(SEPTIC)
kV/wc9iuij
PROJECT FLOOR AREAS 1.
II
AREA DESCRIPTION EXISTING SQ. FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST loll
oAl lo
o' 1
SECOND /5 /3t5 /3(
THIRDI ZA
FOURTH e
Ia
ADDITIONAL FLOORS(DESCRIBE) I
DECK(COVERED?) ,75
may(
GARAGE/CARPORT 655 L55
HOW MANY FLOORS? TOTAL EXISTING TOTAL RD PROPOSED TOTAL EXISTIRG APROPOSED
/"5- 3a! 301 t _
"NEW HOMES ONLY** NUMBER OF BEDROOMS 3 / 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 $_a D
1 AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS 5 FANS I HOODS(commercial) WOODSTOVES
BOILERS Z FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS 4 FURNACES 1 GAS WATER HEATERS
DUCTS S GAS PIPE OUTLETS
PLUMBING
2.. BATHTUBS(or Tub/Show«comm) I SHOWERS 3 WATER CLOSETS troakq MISC(Describe)
DISHWASHERS 2.. SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS 2HOSE BIBBS
i 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.
NAME/TITLE / �!L%%(� iii _ DATE 7////04:9
(Signature) / (Title)
RELATIONSHIP TO PROJECT ❑.Owner 0 Agent ❑ Contractor-6 Architect 0 Other
FOR OFFICE USE ONLY
a NEW a ADDITION o ALTERATION o REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES a NO BASIC PLAN? a YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES o NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES o NO
PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? ❑YES o NO
Bulletin#100–March 30,2004 Page 2 of 4 k\Handouts–Revised\Permit Application