08-103768 ECEI 'VIP �fCIN OF ecr _ t o V ? ( k
Federal Way AUG 4 g 2.008 PERMIT - -
110
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PI. DE EN
33325 DERAL AVENUE SOUTH PO BOX9718 EDER � LI CATI O N
FFDERA2 WAY WA 98063 - _-
253 835 2607 35 6 ___ �_-
CDS
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
j�• rPR�OPERTY INFORMATION
SITE ADDRESS 33 � I C3110, C I anti ' `AcrA1 / aU l LU SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# —i I 0 t✓ I L'4 v - 0 C) 1 (1) J LOT SIZE(sJ)
LEGAL DESCRIPTION(e.g.Acme Estates, Lot 1)
(Attach separate poge for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
0 DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
Srr' Fire SLI*n1 up 11 mod i fy the e4 est i nc1 v3e4 wipe sprl(\kler
SStern -ti) aC.c rnodcAte +he rem 1-1ecv1-�h 'f��5i n-�- I" 1. ` i s+1 n GSP
5 rirklers u)i 11 be r�Dc4�I u're Gess GrI fin C c rnmo�
nu)All Gei>.incei ED sura icm
PROJECT NAME(Nave of Business or Owner Last Name) -ke al1 ,, 1 PQI..i CI LXX1
R PEOPLE INFORMATION
PROPERTY NAME _ PRIMARY PHONE
OWNER kirk Courkt ��D C Mini m,i�,zl( 10t, E-MAIL ADDRESS
MAILING 4 �`'���
-�� 4+v �v�, _. Se.A�He , y0
CONTRACTOR COMPANY NAME ADPL[ ANT N r- ' O F PHONE
V4-11 - f IIZE -s ISMS NNc�- U 11c` (A r�P 1Q c �gatp I�
MAILIN ADDRESS CITY, TE.ZIP. � ggq-a, i CELL PHONE
i l ui�ADDRESS,
0 Ave�: 11n� l�•yl\177.7•, t-TL l` /` -
C(TY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
CONT�2AC'Cp!/ 1GISTRATION N�BE P�oTI�DATE E-MAIL ADDRESS
APPLICANT COMPINF,NAME F/^S 1/y APPLICANT NAME OFFICE PHONE
Srrli '°( Fre �c tfmc (nc, Vero-ft',ca. 1nc� b (2 3)ga(, - 138(.)
MOILING ADDS CITY.STATE,ZIP
'ICICELL PHONE
l?ADDS ave �born , l,u r� 9'21-1),(-1 ( ) -
REIATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑ Tenant 0 Agent Other9mp1O(r'. 2533) gap -0350
PROJECTN PRIMARY PHONE /� E-MAIL ADDRESS
CONTACT , ih eer Dr( (ZS3) 44b - a6 sq II�e rd r, ,Mi-tiq fire.Cem
LENDER NAME Per RCW 19.27.095: 11
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
�` � �,, 1 1 : J ► I+ U ► 'V: ►\ l ,,, '
EXISTING USE L/k,.lJ►' PROPOSED USE , )J U. ._
"U
I,
EXISTING ASSESSED/APPRAISED VALUE$ ,_ r VALUE OF PROPOSED WORK $ I D l 14
SPRINKLERED BUILDING? /YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? O YES a NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
S
— • PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
Sg.FT. SQ. FT. SQ. FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT ❑
EXLSTINO PROPOSED TOTAL TOTAL=STING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
• FIXTURES
Indicate number of each type offirture 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(Commercial/
COMPRESSORS FURNACES RANGES
DUClb GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(orThb/Shower Combo( LAYS(BathroomSmks( URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSE lb Crone.
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 o the relithe '1„, including its officers and employees, upon the accuracy of the information supplied to
the city as a part of th' app atiorf
SIGNATURE: DATE C?`) 2)ICS l 0 '
Property s er: d/or Authorized Agent
FOR OFFICE USE UNL3'r ,
....J.,,...,..,,.�......... _.. .,,.. ,.... ,..,.... ._...,._...... ..,,.._.... ,,.. _.._.......... ,_ ._. ..,.,_.......
a NEW o ADDITION o ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? a YES o NO
Bulletin#100-January 1,2008 Page 2 of 4 kU-Iandouts\Permit Application