09-104968 .EC VED ;Z ,
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Federal Way — — `�DEC' 21 2009 PERMIT
COMMUNITY DEVELOPMENT SERVICES
SF MF CO ME EL PL DE EN 010
33325 STM AVENUE SOUTH•PO BOX 9718 ,, AT I O N
53 ��F�"2 "Y OF FED Tir.„--/--
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The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS 14-15- c5 VJ )1 4 -C- SUITE/UNIT 9
ASSESSOR'S TAX/PARCEL• 0 1 Z. l o 4 - 9 ( 4- 3 LOT SIZE(sf
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach eapamtep for Icy legal�+P�N
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description orinpric in/41�/ipll on this permit onlu)
- -- . �, __ ADD (WE. -IJE, J uJEc.f t b(L4
Sui ST£i .To #3c_AA,t Exi sl-IAJb UH rn $khs-DI l 4
PROJECT NAME(Name of Business or Owner Last Name) L-A.V.-0TPt (\t Doi-g- S(..t{oot..—
II PEOPLE INFORMATION
PROPERTY NAME ,.... PRIMARY PHONE
OWNER �L. ,/l p•iy, 1.)*-‘‘ SC-4100 to CNS.rM Cr ( )
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANTJNAME OFFICE PHONE
c‘124. Svwa�.uw -.. ).)c_. 444.E? - i (Zs3 ) 874 -oU99
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
10 14 130 tvi+ ST , 20o SJMn/k,R- vda c""i° ( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
Zo-oS- loo(,,33 oat- (2C3 ) 8zc, - 1033
COPY cif and required c=2>
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
ley ut et Fcgt.5eitlViC.c.C4.5,
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APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
5, ,t ( )
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT ( ) -
FAX NUMBER
0 Architect ❑ Tenant ❑Agent 0 Other ( ) _
PROJECT 1 NAME1PRIMARY PHONE I E-MAIL ADDRESS I
CONTACT �C.t<- D.(1.Q.0.J I ( 2S'3 ) thv.ct - 001
• LENDER NAME Per RCW 19.27.095:
Lender information is required(/protect value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIPPHONE
I ( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ Z.. O 30/ 1
SPRINKLERED BUILDING? 'YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? RYES 0 NO
WATER SERVICE PROVIDER XLAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
I 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 EXISTING PROPOS® TOTAL TOTAL EXISTING 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(commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom shim() URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Solley
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. /JP
I
NAME/TITLE v POf O e 4 A11 at)s DATE 1 i JOI
*nature) (Title) Y
RELATIONSHIP PROJECT 0 Owner 0 Agent Contractor 0 Architect 0 Other
o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o 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? o YES o NO
Bulletin#100—January 1,2007 Page 2 of 4 k\Handouts\Permit Application