04-104782 �.� icW ,ire -D r - 1 0 ? ?-
. eciel•at Way PERMIT (C1, f , — —
COMMUNITY DEVELOPMENT SERVICES "� CO EL PL DE EN FP
33530 FIRST WAY SOA 980 BOX 3-9718 9718
APPLICATION nnA
FEDERAL WAY,FAX
98063-9718 l)!'`F / /
253-661--0115•FAX 253614129 a O
www.dtgot]ederal wa y.com
The olloutin• is re.uired in ortnation-an inco •lete a..lication will not be acce•ted. Please ••rint le.ibl (in ink)or .
PROPERTY INFORMATION '
1 SITE ADDRES` L WAi SUITE/UNIT
:• . 1) 1 •
ASSESSOR'S •e'/PARC # 1 a !tIZ1 Lr .IZ
EG ES PTIO Acme Estat• •�
dr separate. -for lengthy legal dor o pfon)
PROJECT INFORMATION .
TYPE OF PERMIT '.....s"B BUILDING ❑ PLUMBING 0 MECHANICAL
❑ DEMOLITION 0 ELECTRICAL ❑ ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
COM -rRuc r k tJEkk) 3 13E ,-r44 5PUc SWI(y Re ciPeik.e.g
wt r44 6om us : AecwE Erre G;gaG—
i.rotp„,„- . ,
PROJECT NAME(Name of Business or 0. e) �� =r1 i� ,i
- PEOPLE INFORMATION
PROPERTY NAME \ PRIMARY PHONE
OWNER �CF\k ('>r`� - t 0t.'\ -S !IAC,. (2oG )?fig -247/ .
MAILING ADDRESS CITY,STATE,ZIP
11510 ScurKCEN7ex g--vc TtCWIt),, 141A A. 9-'818 .
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
&_AWEitee-Oom-s)NG TR-r 5(-t • (2s,)2? -241 )
MAILING ADDRESS CITY,STATE,ZIP CELL �� � '
L50 c )7 CEr T€ gi-V I "rO LA1X AJ., DA 88 1((2 ( )ZR �i
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBERFAX
I q-3 q-1 d --1 (Dz._ zi - B L IZ / 3o /oei (ZDc)az -4zQ1
10,
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE .
5c Htsl . 2 25L5. f4 03 /of / 5 .
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
x�1/016(Dele. ROME S 1/VC 13-rPe(c,Ie.. zl-t-Ee_ (;6)248 -241 I
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
6510 Sou N-rE, .bin TuK w/c, Wil.88488 ( ) 23 - 2 -11
RELATIONSHIP TO PROJECT FAX NUMBER
o Architect o Tenant o Agent 0 Other(Describe) (?t(o )242. -42401
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
'3TRIC,k. Zr—rrc1L (2CCP) 2MtS -241 1--1 PliticK t NsmeeN
;nd
LENDER Per RCW'19 27.095: Lender information is, NAME 'Lid
required if project''lalue exceeds'$5,000' 1,4bn1
MAILING ADDRESS CITY,STATE,ZIP
/ .
DETAILED BUILDING G INFORMATION •
f EXISTING USE OA PROPOSED USE sp, . . .
EXISTING ASSESSED/APPRAISED VALUE $ 0.O0 VALUE OF PROPOSED WORK $ 200.000
SPRINKLERED BUILDING? ❑ YES W NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES NO
WATER SERVICE PROVIDER LAKEHAVEN 0 HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
r ,
._
..., PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING SQ. FT. PRO- SED SQ.FT. TOTAL _.
BASEMENT 13'k l"l —
FIRST 4toc :
SECOND O
140
111t'Ili
s
_ /4 / 2. 14.1
THIRD
FOURTH so * 41
€ r' AM
#.
w
ADDITIONAL FLOORS(DESCRIBE) y pit
,,PDECK(COVERED?) ' - w
4
GARAGE/CARPORT `„� (4 5
HOW MANY FLOORS? /(TOT =STING TOTAL PRO ED for a EXISTING AND PROPOSED
3 I y. _4 5
"NEW HOMES ONLY NUMBER OF BEDROOMS 9 ESTIMATED SELLING PRICE $ •Af)_AWN.
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing factures to remain.
MECHANICAL
AliValue of Mecha I,_. i • ,, • a ilk
AIR . U ' EV I OtRRH,;. li`§ ASLeerne
�datl WOODSTOVES
BOI R?tab ,t` 2. FIREPLACE INSERTS NGES MISC(Describe)
�!CQMPR I • FURNACES GAS WATER HEATERS
�/ DUCTS "s 5 GAS PIPE OUTLETSik
PLUMBING
2 BATHTUBS(or Tub/Shower Combo) I SHOWERS 3 WATER CLOSETS
I DISHWASHERS 2, SINKS DRINKING FOUNTAINS MISC(Describe)
i GAS PIPE OUTLETS SUMPS RAINWATER SYST
i WASHING MACHINES URINALS 2. HOSE BIBBS
Lk LAVS(Bathroom Sink.) 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
ant authorized by the owner of the above premises to perform the work for which the permit application is made. Irther agree gree 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 '�`^i4v� lair DATE i/ ����,.�/
(Signatu�,' (Title)
RELATIONSHIP TO PROJECT ❑,Owner ❑ Agent 0 Contractor 0 Architect 0 Other
FOR OFFICE USE ONLY
a NEW o ADDITION a ALTERATION a REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES a NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES o NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? o YES a NO
I
Bulletin#100—March 30,2004 Page 2 of 4 k\Handouts—Revised\Permit Application