04-102733 _ T
of 11101"%or"
Federal Way • PERMITIE�
COMMUNITY DEVELOPMENT SERVICES
S MF CO4, PL �E EN FP
33530 FIRST WAY SOUTH•PO BOX 9718
FEDERAL WAY,WA 98063-9718 2004 D
453.661-4115•FAX 253-661-4129 A P P L I C AT I N / Out
www.dIziofederalwa4.00m l7\ 6 /U �I J
C ITYO FEDERAI WA V l/ 1
The o ilowin• is re•uired in ormation-an inco •lete a••lication will not be acce.ted• Please .rint le•ibl (in ink)or .•.
PROPERTY INFORMATION
OF, E1D
I ... 4 4110P °,,
ii 4 Pi ' CTTE/UNIT#
AS SOR'S TAX ••CEL# LOT SIZE(s _�
L AL DESCRI (e.g.Acme , Lot , ma I'lw it.,
NW, _. itidiaikiliTial yr'
PROJECT INFORMATION •
TYPE OF PERMIT �® BUILDING ..PLUMBING /..MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL 11110 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
CewSTRuCT k MEW 3 13EDe _2r ,T+t 5/10&1-e, P i(--•/ REcIPeL
LJ(-+( If;rvoS Imo- ABoJE AT-r D 4rMA2
a
PROJECT NAME(Name of Business or Owner Last Name)
4Mhrliln111,21)--
- • - PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER I.\k• 'M�. LOtNE5 Ihc,• (2ck, )M6 -Z4-7/
MAILING ADDRESS CITY,STATE,ZIP
105/0 54,0714eENIT FWD Tkv.Itij IVA. ct''SIS�
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Sc IM2,0 s)Nc T -r Ski -a. (20248 -241 )
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
6510 Sourttc iEe $LVD Ttku)u , WA. 188 (20 )Z48 -7411
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER 'EXPIRATION DATE FAX NUMBER
q-3 q-1 d `? 6 2 - B L 12- / 30 /Oct (20(o)a)z -4 zoci
CONTRACTOR'S REGISTRATION NUMBER(copy of card req red with each application) EXPIRATION DATE
5c LItslEx *sz, gsf' a / /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
t n1ElDele Ant-le s /we, - 2 cjc. Z- (X6)248 -241 I
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
651a Sou N-roz guiDT_uKwlc44, WA.q84 ( )erg - 2t 1)
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑ Tenant ❑Agent ❑ Other(Describe) (20,0 )24Z. -4249
CONTACT NAME PRIMARY PHONE
E-MAIL ADDRESS
T21 C.k t (2c c, 24 3 - 1 Pw-tR1Holes
LENDER Per RCW 19.27.095: Lender information is NAME top
required if project value exceeds$5,000 gD(4.16
MAILING ADDRESS CITY,STATE,ZIP
•
•
DETAILED BUILDING INFORMATION •
EXISTING USE PROPOSED USE 5 F,R.
EXISTING ASSESSED/APPRAISED VALUE $ JdrJ
VALUE OF PROPOSED WORK $ ZC 0
SPRINKLERED BUILDING? 0 YES NO//// FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES NO
WATER SERVICE PROVIDER LAKEHAVEN ❑ HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
1
'449b 9q11- ,
1
PROJECT FLOOR AREAS __
AREA DESCRIPTION EXISTING SQ. FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
/006
/.Do
SECOND /18 5 m36 /
THIRD, „ a ;25 ,
FOURTH r ee
ADDITIONAL FLOORS(DESCRIBE)
01: 125
DECK(COVERED?)
f21 1
GARAGE/CARPORT
6,1I tOZ I
HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING MD PROPOSED
2 2.3000 ZSR
**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 $ lA`4 D D
AIR HANDLING UNITS __(____*_ EVAPORATIVE COOLERS .4 GAS LOGS REFRIG.SYSTEMS
B BQS FANS HOODS(commrc(ai) W OOD STOV ES
BOILERS 2. FIREPLACE INSERTS i RANGES MISC(Describe)
COMPRESSORS I FURNACES I GAS WATER HEATERS
DUCTS E GAS PIPE OUTLETS
PLUMBING
2 BATHTUBS(or Tub/sho,,,rcomb.) I SHOWERS 3 WATER CLOSETS(mile) MISC(Describe)
( DISHWASHERS 2 SINKS DRINKING FOUNTAINS
D GAS PIPE OUTLETS SUMPS RAINWATER SYST
I WASHING MACHINES URINALS Z. HOSE BIBBS
4 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 o - ',eluding its of • ees,upon the accuracy of the information supplied to the city as a part of
this application.
'11111410. ,
NAME/TITLE %r/�-�� ���//I' DATE 7/7/d4
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑,Own�B Agent 0 Contractor 0 Architect 0 Other
FOR OFFICE USE ONLY
a NEW a ADDITION o ALTERATION a REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES o NO BASIC PLAN? ❑YES a NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? a YES o NO UP/SEPA/SU? a YES o NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES o NO
Bulletin#100—March 30,2004 Page 2 of 4 k\Handouts—Revised\Permit Application