07-104485 M `. •
IA E® o.
! F+deral Way ��� •
n 2 - ( v r S
AUG 1 3 2007+ ERMIT SF MF CO ME EL PL DE E FT)COMMUNITY DEVELOPMENT SERVICES
33325 DE AVENUE SOUTH•PO 971 9718 , ,I C ATI O N
FEDERAL WAY,FS
WA 98063-9718 TD /
253-835-2607•FAX 253-835-2609 CI'("11'OF �; Q
www.cittioffederalwati.com BUILDING DEPT.
The following is required information-an incomplete application will not be accepted. Ple Hint legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS 50 1 S . `3`3(a-NA". SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# / a G , ( Q C) - C7 2, -LI ® LOT SIZE(sf 1C,.�6
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) 1"--{�J `"�Qt
V ,,�,t1
`�\cam-2c- tom. kcp-n r 1.
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION pELECTRICAL 0 ENGINEERING IRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
JA
A i--i C� Silo�5 L F '� Cr I t-e rpkcu`_ �'�i. '.^ i. ,A,o,f-:-c"C_o - 0./1/4_
/i ,P_V Z c-e . R.10 :f S* -s-k. -0 4 # ikLS o ;-&0.4caak o,ns%, 6,,3 at.-€i \eQ
't-C? r --k----42-.A_"....,4- `1,A"-`t f B J,Pwit&-e.h
PROJECT NAME(Name of Business or Owner Last Name) o tsv`kCti-i A- T lCA_T A. 1'),e,p-}-.- c °.eV ern v-c-
m PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER FS T C .e...4-4-Q- t1) Q0 C? „ ( ) -
MAILING ADDRESS ITV,STATI ZIP E-MAIL ADDRESS
605- s r 37(0-fA. 5-1;-. Fe�'w-q,e_ 4414y
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
s -tkA-ri:;rc.SKscew.s fit. Le.c-u"-. c 4-5 (25-)) 2qF - 2eYDa
MAILING ADDRESS CITY,STATE,ZIP ` tut
CELL P'H1/ONE "2-0-0
,n
CITY OFAFFEDERAL WALe C YBUSINESSLI A-4-c...n) NUMBERc EXPIRATION DATE i L 4 FAX NUMBER O fe - r� V
1 Ct — 77 •- bo®b CC- " L- ('2.(3/(0 (2J-3 )12 4 -b7 2 ,
COPY of card required CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
with each application b 5 7T,AfFS TiLi to L 0 4(2-0/0$
APPLICANT COMPANY NAME APPLICANT NAME
OFFICE PHONE
6f1,-kucc:re- S..(' A--e44A.S u 1-t. 1--e-0-,,.. Pc le..> ( is'3) ?tn. - co sz
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
ccc>6 cyA.k,. ta--..-e- . c "tRcb,,,,t ,1 wA-. t3 a-92 c-i ( 2S3) feote - 422a-o
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant b Agent pPOther �SZ •14,0N 9--r (25, ) Qat,, - ()7 2.4
PROJECT NAME PRIMARY PHONE
E-MAIL ADDRESS
CONTACT Le-o- c-Pc.krti-S (2S`) ) 2q g- - ?eV Z.
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ (Co I ertrQ
SPRINKLERED BUILDING? DYES ONO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES liaNO
WATER SERVICE PROVIDER ❑ LAKEHAVEN o HIGHLINE ielrACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
IN PROJECT FLOOR AREAS
-mm
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ. FT. SQ.FT.
BASEMENT
FIRST
/ c, fte
SECOND r 1
1
THIRD t S- , r b
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT 0
NUMBER OF FLOORS EXISTING PROPOSED TOTAL rarAL ExtsrIo SF TOTAL PROPOSED SF TOTAL SF
""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$ (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(commerdal)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSE1S(Toilet)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
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. A� /
NAME/TITLE L'L FR+�FNCH /r(A IA4d'ta`SS/L DATE Sj l(/07
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner ❑Agent contractor ❑Architect ❑ Other
o NEW o ADDITION ❑ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? ❑YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES o NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—April 2,2007 Page 2 of 4 k\Handouts\Permit Application