04-105118 �� RECEIV`ED
Federal Way Wa4 e 0c - --I— �� ( 4—
SEC 1 PERMIT
COMMUNITY DEVELOPMENT SERVICE SF MF CO ME EL PL DE EN FP
33325 8T"AVENUE SOUTH•PO BOX 9718
2FsE3D-8E3RsAL2677•Y'EVAX 295
830633s-927 TY OF FEDER � P LI CIT I O N
° / /
u,u,u,.c,lioJ]ederahaaq.com BUILDING D11-
The following is required information-an incomplete ap.lication will not be accepted. Please print legibly(in ink)or type.
•..n;`.,.;- '.. - ' . •.PROPERTY INFORMATION .
SITE ADDRESS -- — - L�At-Cr
1 ^ SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 3D("( • °I at C 1A-S
LOT SIZE(s_f)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
/Attach s mate page for Iccg[hy legal des -pnoc)
`- ■ PROJECT INFORMATION .
TYPE OF PERMIT ❑ BUILDING LI PLUMBING ❑ MECHANICAL
❑ DEMOLITION 0 ELECTRICAL 0 ENGINEERING ACFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
T;I, f--c, it ,51m0-- -) Fogy c w,. , •.R.EL(:',C.i9- e t 5%/A.0 G1 Pito p
3 p 2 1 AL tc.C_c- s
1
PROJECT NAME(Name of Business or Owner Last Name) V'-'.1 / .)O%(L99,
PEOPLE INFORMATION • .
PROPERTY NAME
OWNER PRIMARY PHONE
MAILING ADDRESS I CITY,STATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME
OFFICE PHONE
AD04AIL�p2 F(oP;- ( ) -
MAILING ADDRESS CITY,STATE,ZIP
S z CELL PHONE
F 4
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER ( )
EXPIRATION DATE FAX NUMBER
CONTRACTORSI
REGISTRATION NUMBER(copy of card required with each application) / ( )
AT-)—
T, A141 7 �� -q EXPIRATION DATE
NY f1 - - Us- 1 o/ l' ccS
APPLICANT COMPANY NAME APPLICANT NAME
APv�c�-2 F OFFICE PHONE
Ft Przzr :r,e'[ ` licK �i=geE/2 (Zs•3)e -63 `la
MAILING ADDRESS CITY,STATE,ZIP
A O1 p�� /5-43
��./ CELL P,)R�O)NE
RELATIONSHIP TO PROJECT V �'�/NV/�� �� ('�--- � �
FAX NUMBER
0 Architect 0 Tenant ❑Agent R4-0ther(Describe) Co-i r/2 1-c re'/t.- ( ) -
CONTACT NAME ,�e� PRIMARY PHONE
I V tris ,e7e12�;(A E-MAIL ADDRESS
ti/�l�l:r / (Z)3) 2a4 =63,€ z- me_84 u•C w44L4.5(7Ailt
LENDER Per RCW 19.27.095: Lender information is r NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
"..7.. '..R DETAILED BUILDING INFORMATION •
EXISTING USE
PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ / S—C7U
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
' • P OJECTFL00RA\ . ...---.:-----------.----- —
REA6
AREA DESCRIPTION EXISTING SQ.FT. PRI. .SED SQ.FT. _ TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH _,
- ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
TOTAL EXISTING TOTAL PROPOSED TOTAL L=ISTING AND PROPOSED
HOW MANY FLOORS? EXISEXISTING
•'NEW HOMES ONLY NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type offuture to be installed or relocated as part of this project Do not include existing factures to remain.
of
MECHANICAL 5 O C�
Value of Mechanical Work $ 7
EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
AIR HANDLING UNITS
BBQS FANS HOODS(commrciaq WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING WATER CLOSETS Roa<q MISC(Describe)
BATHTUBS(orTub�show,combo) SHOWERS
DISHWASHERS SINKS - __-_ DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS _ HOSE BIBBS
LAVS(Bathroom sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
�.=3 8IGNATQREBLOCK { ��}�. ...
- .* F =DISCLAIISERI - -
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 TITLEqe;/ . ,,,Jt ASI/IX ( DATE l 2- Ili-6
NAME/
TITLE (Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent kiLcontractor O Architect ❑ Other
1
i
E FOR OFFICE USE ONLY
a NEW a ADDITION a ALTERATION a REPAIR o'TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? a YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES o NO
t NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO —
PLATTED LOT? o YES a NO DEMO PERMIT REQUIRED? a YES o NO
f.
Bulletin it100–March 30,2004 – Page 2 of 4 k\Handouts–RevisedWerinit Application