05-105427 i�"1 I(
color� , 1 0 5
Feder Way PERMIT
coMMUN1TY DEVELOPMENT SERVICES r)t'^7' y�
ON1SF
F CO ME EL PL DE EN FP
33325 AVENUE SWA 98063-9718• BOX 0718 l4. II 4 p LI CATI O N
FEDERAL 07Y,FAX
"� O1L
253-835-2607•FAX 253-8352609ITY OF FEDERAL V61AY
• NCDEP'
The ollowin• is r-.u' . . a n-art incom•late a.•lication will not be acce.ted. Please •tint le ibl (in ink)or 1•
• PROPERTY INFORMATION N //
SITE ADDRESS SUITE/UNIT# 1T
ASSESSOR'S TAX/PARCEL it / ' 3 - Lr) 7 ' (/ LOT SIZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) CDL�L� r¢ �STf1 Tom' Le 7- f
(Attach separate page for lengthy legal description)
PROJECT INFORMATION
TYPE OF PERMIT Pr UILDING I 'I1LUMBING R—MECHANICAL
D DEMOLITION 0 ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
TWD —STD/Y', P1/ .Z) ��A�l , �S//v 9I- FSI/�'//L y//�S/I��i�IG
J/(//7 /� 4 4,9'� ' 4,7 , /45/NE/
�LEI/4-7-fD/1/ / NEW G�p/1C�-T�GCGT/UM.
PROJECT NAME(Name of Business or Owner Last Name) •-(94_ z_/ T,q-T Lp7'"-''0;&
• PEOPLE INFORMATION
PROPERTY NAME yI•��
OWNER G //T //1/ - • PIPR!IM3PHOONNE o
d *r
MAILING ADDRESS CITY,STATE,ZIP
�O �oX 7379D f��r �1/u pliAL 9 3 73
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICEPHONE
6)/9-ng �om s 141-13,0v� /moi; 25(f ( l .ere:
MAILING ADDRESS /1 CITY,STATE,ZIP// CELL PHONE
( l
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER G�+
2g -B L / / �6g)53/
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
�.D G[. /►l.b13 f/a Z3 41 q / /a / a
APPLICANT COMPANY NAME APP/PPL1L CANT NAME OFFICE PHONE
S3u/ r 1/D/Y/es /CALL/ 1�Y� ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( l
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect 0 Tenant Itf/0 Other(Describe) ( ) -
CONTACT NAME PRIMARY PHO E-MAIL ADDRESS
�LL/ P53) /87 a ( ) // oun�lbua/thory '.CL/y/
LENDER Per RCW 19.27.095: Lender information is NAME /�
required if project value exceeds$5,000 //0/ 4-Aj<
MAILING ADDRESS
CITY,STATE.ZIP
/ • DETAILED BUILDING INFORMATION
EXISTING USE /�! PROPOSED USE ( i
A//9--
. >C ,1, SEe
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES RANO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YESrrr . IO'r
WATER SERVICE PROVIDER rd'CAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL) T
SEWER SERVICE PROVIDER 6'1 AKKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
4
1_ - : ..
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
---p' FIRST
.
--� SECOND 7 z-
THIRD
FOURTH . .„._
z
g�p
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?) ,J 2 n ( ' ,
GARAGE` ARPORT❑ ,���i/-
/*IV /�L j� j
ERISTt1W TOTAL TOTAL XXJSTINO SF TOTAL FE F [ �`('J
NUMBER OF FLOORS -) J. / ' / &,-)...
**NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ -/U/ `Y
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 // aaa
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS a REFRIG.SYSTEMS
C' BBQS J FANS o HOODS(commercial) a WOODSTOVES
O BOILERS / FIREPLACE INSERTS / RANGES 40 MISC(Describe)
t ' COMPRESSORS / FURNACES / GAS WATER HEATERS
//,'" DUCTS / GAS PIPE OUTLETS
PLUMING
CD BATHTUBS(or rub/Shower Combo) / SHOWERS .• WATER CLOSETS(Toilet) D MISC(Describe)
DISHWASHERS SINKS e7 DRINKING FOUNTAINS
a..'. GAS PIPE OUTLETS D SUMPS O RAINWATER SYST
f WASHING MACHINES 0 URINALS �-- HOSE BIBBS
7l LAVS(Bathroom Sinks) O 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 /% -�J 7!/SOUND jGULT 1T mi �� "o'-
A/ . DATE ! o '�—6v
(Signa ) (title)
RELATIONSHIP T PROJECT 0 Owner de<ent ❑ Contractor 0 Architect 0 Other
FOR OFFICE USE ONLY
o NEW o ADDITION o ALTERATION 0 REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES ❑NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100-January 7,2005 Page 2 of 4 k\Handouts\Permit Application