09-100468 CITY OF D? _/ t0 4fg
F r I Wi
Fedeay FEBFEB0420x9 PERMIT
COMMUNITYDEVELOPMENT SERVICES SF MF CO ME EL PL DE E FP
33325 8 ERAENUE 80 'X PPAYI CATION TD
FEDERAL 07.F 0 3- 'l] ` ` / /
253-835-2607•FAX 253-835-2609
wuw.ctuo%iecderatwatt.cum CUS
The ollowin• is re'uired in ormation-an incom•lete a••lication will not be acce•ted. Please •rint le•ibl in in or pe.
f - PROPERTY INFORMATION
/ '/y��
SITE ADDRESS '3 Co //A�L S. i-e e ( 1 k`1 1'�ll,{,y. [VI N SUITE/UNIT# 19/6)
ASSESSOR'S TAX/PARCEL# 1 a 6 5 0 1 - (0 0 6j V LOT SIZE(sfl
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ,ELECTRICAL ❑ ENGINEERINGFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only) !�
d64-I"�m peiVellicn v`- r Su"/e 46, A.W ( Sr)laGr(7 .,i' Z.:f-Orc) a 5er-hf?1 2 L
1D(0$ robe alytif)g °ice, SYs _
i ,SIZz‘-i
PROJECT NAME(Name of Business or Owner Last Name) C41.4'‘ Rob(n ''c
• PEOPLE INFORMATION
PROPERTY NAME / _f L� PRIMARY PHONE
OWNER G6 0 ef) CJ'lane, i,-,L C ( )
MAILING ADDRESS CITY,STATE,ZIP
uo C iAte 5, ib --( 4eC16,cl 1,1,..1 Wc. £'7o(3
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
klRS IOGC0 ALA21\4h.-- (a(9) 3
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
IaS-3 S.liCc1 St. 44-ie W 'OW ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
20 - 00 - 1 v k k a -B L /2 / 3( lO 1 (a ) Sao- Tai {
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHQ,U.E
' iki-1:1r�f 70N) Al-Ai2 CI! t� 1.�(�r, AG 1 (c9& ) r -` 6
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
I d3 '5 591A. 5 . Gec+f le 41a %I L( ( ) -
RELATIONSHIP TO PROJECT + tt FAX NUMBER
0 Architect 0 Tenant 0 Agent 7 Other(Describe)l.dh'� C to.c ( ) -
CONTACT NAME� �nPRIMARY PH E �/ E-MAIL ADDRESS
Mark M ILA:,r. ( ) 3dir - 30 O himc,! i L)C.I n e1 4 lamJc.rv.tp•r.
LENDER Per RCW 19.27.095; Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 1)Z2‘-'t
SPRINKLERED BUILDING? ` YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
iS 0
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
NUMBER OF FLOORS =STING PROPOSED TOTAL TOTAL Wan=Sr TOTAL PROPOSED SF TOTAL SF
**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(Commereia) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS Toilet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAYS(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. f� c�
NAME/TITLE '\ � C S DATE i�I (0 1
( gnature) (Title)
RELATIONSHIP TO PR ECT ❑ Owner ❑ Agent 'Contractor ❑ Architect ❑ Other
FOR OFF E USE ONLY'i C,L,11'0,,
❑'NEW o ADDITION ❑ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES ❑NO BASIC PLAN? ❑YES ❑NO
ZONING DESIGNATION CHANGE OF USE? o YES ❑NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES ❑NO DEMO PERMIT REQUIRED? ❑YES o NO
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application