06-104684 RECE,ED 0
CITY OF
SEP 1 5 2006 aL - / (-) 4 l(
Federal Way PERMIT '
CITY OF FEDERAL ti SF MF CO ME EL PL DE EN FP
COMMUNITY DEVELOPMENT SERVICES BUILDING DAP33325 AVENUE SOUTH•PO BOX 9718
FEDERAL WAY,WA 98063-9718 P
P L I C AT I O N
/ /
253-835-2607•FAX 253-835-2609
www.eittioffecteralum.com
The ollowin, is re•uired i ormation-an incom,lete a,•lication will not be acce•ted. Please ,rint le•ibl (in ink)or t_ •e.
• PROPERTY INFORMATION
. (p •
SITE ADDRESS fit. : t4 - `' • K SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# ! oz Ce 5 (X qf - c2f 0 0 LOT SIZE(sj) /5t '
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) ,t c �k CCA..wN p v i C.-c• C...12_ at-Li__ '',,J 0\
(Attach separate page for lengthy Legal description)
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING GT,FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only) /
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PROJECT NAME(Name of Business or Owner Last Name) (2 CLvvt yr 9Cj ,�+tC_
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• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER 'l tt‘iee_ -Tktr-k i St F-t(, .1 L LC- ( )
MAILING ADDRESS CITY,STATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
':7:-% -t'( � i-e S ti s4-e s t1nq�. (—et,,,"Pc,..,-1,.--s (.A.5* ) ele& - /&6)'i, _
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
Ito b 544L. tk.re_ - TA_c.o=v...es_ 1 wA, e25<ii y (fir)) 4o& - 9zert:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
- - - / / ( s3 )ram
B L :233c,
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
I'''k L Z H - L t `i' L ID < /2 h'- /2cr)i
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
S0. ', ' :"-e S%(SA"e..w . WI.Cr L. .. eco-tr:> ( 1, )j`4[, - ilk e)
MAILING ADDRESS -CITY,STATE,ZIP CELL PHONE
%1 b(., S H 1-k_ A\i.e.— c 'Tc�C-c>ra-.) , w 4, 9 VL/ z! ( 1,) 4 U!r - /72-cr-c)
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑ Tenant r3 Agent 0 Other(Describe) ( 3 ) Y2 4, - 02.33-0
CONTACT NAMEPRIMARY PHONE E-MAIL ADDRESS
L 4- •..ti `?(Ark-, (YT) ) << c. - /2`:S e,
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE C.', 1 C , 1Z-
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ ' ,21Ct'(
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
l
•
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
57" '30/Cs--v-t.) 3 o, r.-c;ti,
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(Commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(orTob/Shower Combo) SHOWERS WATER CLOSETS(Tmtet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLISIS SUMPS RAINWATER SYST
WASHING MACHINES URINALS 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.
NAME/TITLE Xf —� 15...../'4,4 /11Gt st et-��.'!l DATE c�/I 3/
Lc 6"
(Signature) (1Ttle)
RELATIONSHIP TO PROJECT 0 Owner ❑Agent „contractor ❑Architect 0 Other
FOR OFFICE USE ONLY
❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? ❑YES ❑NO
ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? ❑YES ci NO
PLATTED LOT? ❑YES 0 NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100—January 1,2006 Page 2 of 4 k\Handouts\Permit Application