05-106317 RECEIVED. o s-/oo ((q
•
0 - _ d
Federal Way � �V , � SEC 1 2 2005 ( (� � ( 7-
cEPERMITIIIA
FEDERAL WAY
COMMUM7YDEVELOPMEM'SERVICES • SF MF CO ME EL PL DE E FP
33325 8TH AVENUE SOUTH•PO BOX 9718 i 20AP p LI C A Td ' ':PT. p
FEDERAL WAY,WA 98063-9778 /
www.
253 FAX 253-835-2609. I
www.cit too uo(jederalwau.corn
The oilowin. is rel; L, -. .. ation-an incom.lete a.•lication will not be acce'ted. Please .rint le•ibl in in or
. ■ PROPERTY INFORMATION
SITE ADDRESSi.cz s, •�-�j f� PL- , SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 0 S ? ( O ( - rJ ?- ( i LOT SIZE(s)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING 0 MECHANICALS f'
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑, FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onl ( - -_
P s'e4 I/ ( 3 2 s e rl yr tiler s' ,f6 �.v4 .f�
�
PROJECT NAME(Name of Business or Owner Last Name) 6 I V i
PEOPLE INFORMATION
PROPERTY NAME
I PRIMARY PHONE
OWNER .PP LA1 C4 la I d IN G_/ ( ) -
MAILING ADD ESS CITY,STATE,ZIP
CONTRACTOR CO��.,,{{PANY NAME APPLICANT NAME
f OFFICE PHONE
buPlfl iteIew t-ire-Pre—l-wyN jMtie. 0t c(n ima, (:moi ) 64J/ - i4.6
MAILINGIL4AD RESS C ,STATE,ZIP
J CELL PHONE
°`' 64-W „CA,
„�,yra1 rk'1. e 9g1.375c.=c ) 5 '/ - 4-43-6
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRA ION DATE FAX NUMBER
/ / ( '-1, aril. i�4- - 01 (OS
-B L
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
vC ► t= - —c
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
Ov'k alrcit CAr ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMB ER
0 Architect ❑ Tenant 0 Agent 0 Other(Describe) ( ) _
CONTACT NAME PRIMARY PHONE �
4 ; `<,ty �t4, v�.�-C 0ri f-y\ (-25-3) 3.iii- r E-MAIL ADDRESS
LENDER hi,:- o er,,»n artadEto iI NAME
4
MAILING ADDRESS CITY,STATE,ZIP
!t
• . . . .. . . • . . .• - IIIDETAILED BUILDING INFORMATION
EXISTING USE 0, - - a,C ''(^..-z PROPOSED USE J F
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ lLJ 0 U
SPRINKLERED BUILDING? r YES NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a NO
WATER SERVICE PROVIDER LAKEHAIVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDE• ani LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
. . -. PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ. FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(OE$CRIBE)
DECK(COVERED?)
GARAGE D CARPORT 0
EXISTING PR2SPOSED TOTAL � TOTAL EXISTING SF TOTAL PROPOSED SP d i ,..„- AL Er, f
NUMBER OF FLOORS
';, j4.1 gala; o f , I lam: '''
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURE:* `
Indicate number of each type offxture to be installed or relocated as part o is project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS VAPORATIVE 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 Tub/snq(4ercombol
SINKS
SHOWERS WATER CLOSETS(rode) MISC(Describe)
DISHWASHERS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING M/1CHINES URINALS HOSE BIBBS
LAVS(Bathrooms tl sl 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. /21/'
NAME/TITLE 1�ill
rec,; �+ DATE ( Z f.j (o_
(Signatu a (Title(
RELATIONSHIP TO PROJECT ❑ Owner 0 Agent t 'Contractor 0 Architect 0 Other
E
g.... _,tA,yS
41
t MTEAN • ®.P R NYESFIES2EAION RE ,- , AA O e �1t°��Z �0;� ® a , g:;t77, CE�JFUSr ,. � aYE701.61,0,v1':-..;.. .?® '''''':"744.17=,:.'::;:,_A.._,17.,:—.:
TO 14f �UPSEPA/SU - ,
M® � ESI ;�,: : ' .40-`• e VOt i a ;ieWB, ,, Dil. `'S °�D; @ s a _ MIN te' . : j' , �
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application