04-102647 arr of i • ��� r
Federal Way ECEl j --E- 0 2 _17__(4:
FEMIT
3530COMI FIRST'UNITWAY SOUTH PO F CO ME ��L DE EN FP
JJ530 FIRST WAY SOUTH•Po BOX 9718 ,,,yyy��� T� //'
FEDERAL WAY,WA 98063-9718 , 1 0 2.pP APP
L I C Z I O N
/
253-661-4115•FAX 253-661-0129 /
www.dt yo ffederal waq.cur. '
{ = �F� ..
1rA -gEV E l!
The oilowin• is re.0*)e. ( Lw.d 1.,.'Tan Inco .fete a.•lication will not be acce•ted. Please •rant le.
Ibl (in ink)or
PROPERTY INFORMATION
9TEADDRESIP 0 ,
- • T t I #
: ' at
II. i 111 fill
,o�I ,,LotOr
ma... s rate•.l for lengthy i_- ..aiption).. /
. - PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING (3 PLUMBING 0 MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
ComST(2uct k me v.) 3 BEC .,AFAII4 5/ J LE. aM[Ls/ {2£c1PeN6Z
lnl(rH &J J u) Zai A&jE Arroc+1eD c kgAc -
• — . gr
fl
rPROJECT N. E( o - j '` , ;, (L�Ee.. �(1)JJIA
t
- • PEOPLE INFORMATION .
PROPERTY NAME&
OWNER �/�I\ktM�ACWSES 1 •
MAILING ADDRESS i I (PR'I MnARY PHONE
� -���
15/A 5rHc€�� CITY,STATE,ZIP
/Vl / 62 $W1) TKW(Vt./ 1+ Ci818e)
CONTRACTOR COMPANY NAME APPLICANT NAMEOFFICE PHONE
IS
NEI' e.,0OMES)NC. T -r S(-4sA, (202118 -24 ) )
MAILING ADDRESS CITY,STATE,ZIP
CELL PHONE
6590 Sou-r-t(crime EL-VD 'rokat.A WA Q818B (20 )z48 -24`) I
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER 'XPIRATION DATE FAX NUMBER
(1-/
9.
-1 C3 . 1 6 Z - B L IZ / 3o /oct (20c)29Z -4z zi
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application(
3cH E I *sz q s f EXPIRATION DATE
APPLICANT COMPANY NAME APPLICANT NAME
HONE
Y/ //JEtLE . /Jot' 1E 5 /WC, 7/0U_ Zt-i-E e_ (F(x6)248 -241 I
MAILING ADDRESS CITY,STATE,ZIP
CELL PHONE
X10 U U'r /7 gG'D T Kwl[�1 WAg/g�$g (244° )2.4 - 201)
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect 0 Tenant ❑Agent 0 Other (Describe) (20‘ )242_ -4249
CONTACT NAME PRIMARY PHONE �'' 1
r t/ �1^1 E-MAIL ADDRESS
Cot tTSG j� ca. 2"fYS Lei ! i' 'fRI140meS
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000 14011/416
MAILING ADDRESS CITY,STATE,ZIP
DETAILED BUILDING INFORMATION
EXISTING USE -7`- PROPOSED USE S
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ aX0,40Q�
SPRINKLERED BUILDING? o YES NO FIRE SUPPRESSION SYSTEM PROPOSED o
/REQUIRED. 0 YES \44) NO
WATER SERVICE PROVIDER�t+I LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE
SEWER SERVICE PROVIDER LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC) (WELL)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING;CE.FT._ PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST 134 Io ' 246
SECOND 1 i O 47Z_fb
THIRD
FOURTH
a
ADDITIONAL FLOORS(DESCRIBE)
•
DECK(COVERED?)
rte►
GARAGE/CARPORT
C1 _
�
HOW MANY FLOORS?/7 TOTAL EXISTING TOTAL PROPOSED TOTAL EIOSTDYG AND PROPOSED
31193119
'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 $
r k
C AIR HANDLING UMTSEVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS -.— )< HOODS(Commercial) WOODSTOVES
BOILERS 'L FIREPLACE INSERTS I RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS 5 GAS PIPE OUTLETS
PLUMBING
2 BATHTUBS(or Tub/Shoo rCombo) I SHOWERS 3 WATER CLOSETS(rose) MISC(Describe)
I DISHWASHERS Z SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS 2 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 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. ryry�� /�
NAME/TITLE / &tT:V MAS)A6IE2 DATE 6/3 0/0
(Signat ) (Title)
RELATIONSHIP TO PROJECT ❑:Owner o Agent ❑ Contractor ❑ Architect o Other
FOR OFFICE USE ONLY
a NEW o ADDITION a ALTERATION a REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? a YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? ❑YES a NO
Bulletin#100-March 30,2004 Page 2 of 4 k\Handouts-Revised\Pennit Application