08-102996 ECE1 oath King Fire & Res
Approved
`Irrof 410` JUN 19 2008 ■A s D: a' .• — — _ j 7 76,Federal Way •4 • -t ached details
COMMUNITY DEVELOPMENT SERV( ®F FE' i'l t� ► SF MF CO ME EL PL DE E FP
33325 BTM AVENUE SOUTH•P�y�'`'y�,71 • T11 !
FEDERAL WAY.WA 98063•7/TN r.� YL A t �_ I. To / /
253935-2607•FAX 253-635-2609 .� VAMP, ) I J
mww.cil4n((edernlu;aU.mnt Date
The ollowin• is re•uired i ormation-an incom•lete a••lication will not be acce•tem•rint le•ibl (in ink)or _ •e.
�J'( •( PROPERTY INFORMATION '-�'i�� l�
SITE ADDRESS 3`,Ltov q it ie. '3s SUITE/UNIT# a03 �� )S
ASSESSOR'S TAX/PARCEL# 9 3 L S Go
. ��Si-I -- ii 0 Q Cj Q LOT SIZE(4)LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) GO' DnQ I•„LC
(Attach separate page for lengthy IegaI description)
I. PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING ❑ MECHANICAL
❑ DEMOLITION ELECTRICAL 0 ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu) t
1engin- )M?fOVemCnkk 40 '—'Sk-iilc --si rc i lath 5'j5F2m. / c\ I ban 6iTtA,e J i s+rnha-
Anc\ '1 ScnoVe etekoek-or, ?e?\c,cP A exeSFi,,s `Ys()Ve rtPlecl 0-1-, a he - clefe or.
PROJECT NAME(Name of Business or Owner Last Name) -16nCk �tin i,� Yea/Vt.,t' % 46, ‘1,(440.,,z,_,
• PEOPLE INFORMATION
PROPERTY NAME p �'j PRIMARY PHONE
OWNER V
(›Rklen '1one �LC_ ( ) -
MAILING ADD S CITY STATE,ZIP
Sao 106+1' / etE#110 1ClleJue. Lie-- ��CbL-(
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
IA MAILING RFSUkn`,L t ADDRESS
/l T e`c(Y\ i 1 (09
l06 ) - 3A5/5/
J CITY,STATE,ZIP CELL PHONE VV
Lay
/\
Ia53 S JUclksal% Sem ltle �A °( � ( )
i 11 CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
�lLkkil J C2--6 Q--1- (2 4-. lo a J- B L /69 / 3/ /d ((��6 ) 0`�0�1 -r1 1`�
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
NA65 iH1L .Iacic ca /a/03- /d009
APPLICANT COMPANY NAME /� APPLICANT NAME OFFICE PHONE
VICt h(nc )rA
, 'nim T.11 c, (O ) - 3aei
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
1453 S 3c,U(/sO' Sk W4 cr81yy ( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent ❑ Other(Describe) ak) 399, - 7r-P4-1
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS ijc,(T( f
MC,rl{ Me-71-1 wetir ()b ) - 3N� mc_ int stns r ' Can
LENDER Per-RC'( 19 27`0$5 Lenderiifornp1on is i, NAME
required=(yproject`value exceeds$5;000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
Is DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ S1 SOO
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS 55785150 PROPOSED TOTAL TOTAL sxrsra 0 BF TOTAL PROPOSED al TOTAL ar
"NEW HOMES ONLY"' NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
• FIXTURES
Indicatenumber 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$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(Commerda)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(oriub/Shower combo) LAVS(BaeuoomSinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS froiks
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best of my
knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with all applicable
City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the issuance of this permit
does not remove the owner's responsibility for compliance with local,state,or federal laws regulating construction or environmental laws.
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, 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 applica .n.
s
SIGNATURE: / DATE 'Th 6)6
, �. ' Property Owner and/or Authorized Agent
a NEW o ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? o YES a NO
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application