07-102177 4111)
ar~oF O ,2-- / 6 02 / 7
Federal Way 'TR 2 3 2007 PERMIT
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE Ell FP
33325 BTM AVENUE SOUTH•PO BOX 9718 �'P L I C ATI ON / /
FEDERAL WAY,WA 98063-9718,1 r'Y'Q�F�®ErR1 '
253-835-2607•FAX 253-835-2609 �U tt:..��NG 6/
www cdoffederalmay.com
The following is re.uired information-an incom.lete a..lication will not be acce.ted. Please •rint le.ibly(in ink)or : •e.
C� A-^_�■ PROPERTY INFORMATION
SITE ADDRESS .) '3�00 I }' - (' S SUITE/UNIT t I I q r f j f
01 mo1
ASSESSOR'S TAX/PARCEL# - (0 C5 0 1 - 0 Cl (a (I) LOT SIZE(sf) (�
LEGAL DESCRIPTION(e.g.Acme Estates,Lot)) �Q�dQ n�� l CSL vJ. C, .---c S t,->.'c:.�_. PD-f kC U.J 01
(Attach separate page for lengthy legal d'scriptioN )
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
❑ DEMOLITION g ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
AA\hc- t ,IJ.Z, tist�w (--1'y -.t-ry " s�S .,n c^
3lnrv. IS'd'roLe..5
t
3)1-31.1[,/.0 a 3.4 t erti-, I `J vvLra t`- V- •s( - I,‘/31-1-0 0-e
RDJAAo J.1^<=-3 L S V\AOa S
I
PROJECT NAME(Name of Business or Owner Last Name) � ��Sk'�,.L,� ,�(,( l `14 '
--tt‘
• PEOPLE INFORMATION
PROPERTY NAME ��C_}� L r L- 0'
PRIMARY PHONE
OWNER �.-/ CQ.A,1 S v C (z 3) 735 -397-
MAILING ADDRESS CITY,STATE.ZIP
-7.34 `Ii 11 /)N-C-C5 t--ute v 71 vJ .jt vu A 't co 003
CONTRACTOR COMPANY NAME APPLI, ANT NAME OFFICE PHONE
vhi-s i,,...r�\.o:, v,,, i
� - - tet,, Pc 1 (2cL3) 3 -3z.ffi
MAILING ADDRESS` t i1 Crr ,STATE,ZIP CELL PHONE
rz6 3 S. )af,lc-jGln ST eE111z tAhekGN hoz_ ( ---) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
2 v 0 0 i Q L L Z 9' 006 E 11-/ 31 /C.7 (2o ) 3z - '7Z r
C IJ'I'RACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
'CAS - 1412 `- C3 /Vc11 / 07
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
' A.9.-. S a6V-i __ ( ) -
MAILING ADDRESS CITY,STATE.ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent ❑ Other(Describe) ( ) -
CONTACT NAMEPRIMARY PHONE E-MAIL ADDRESS
�c' .e-,A 1010 ,.15o v, ( 204 ) 3z0- 32000 } tl . .sk ,›I.--.c.
ms J(�.
LENDER ,' o NAME
an ePt
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE _
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ ( 5 2-(c. . 9:2—
)
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
•
1111
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. sg.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT LI
E87HTWG PROPoSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL flF
NUMBER OF FLOORS
"NEW HOMES ONLY** NUMBER OF BEDROOMS 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 $
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(or n b/showercomtw) SHOWERS WATER CLOSETS Roue)
(Describe)
DISHWASIiERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS 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 ini 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 cit is officers and employees, upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE 'MDATE 1 1 Cal 7
(signature)
(Title)
RELATIONSHIP TO PROJECT CI Owner
❑Agent Contractor ❑ Architect ❑ Other _
y
:.
� � o
Bulletin#100—January 1,2006 Page 2 of 4 k�IIandouts\Pernut Application