09-104967 �„ 01 -- 0Oo 1t-k4
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COMMUNITY DEVELOPMENT SERVICES (� R M I T SF MF CO ME EL PL DE EN ED
3332FEDERAL WAYSWAT 98063 90 89718 DEC, 2 Ip 7'1 T T CATION
253-835-2607•FAX 253-835-2609
www.cifuo((ederalwa4rorrz FEDERAL\N .�
The followingC iree info q n-an incomplete application will not be accepted. Please print legibly(in ink)or type.
ll.•�� • PROPERTY INFORMATION
SITE ADDRESS 14-tS SIIJ St 4-T" ST SUITE/UNIT it_
ASSESSOR'S TAX/PARCEL# 0 1 Z I C) 4 - 9 I 4" 3 LOT SIZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
IN PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING X FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
ilsUn Ut!4s t S•� vJfc r 4, DRM SYSTEMS To Il1>LI.t) St.1400,.... • ,
PROJECT NAME(Name of Business or Owner Last Name) k.---Ac K_1211-ft 1sA t DD-f- SCS )o`
I♦ PEOPLE INFORMATION
PROPERTY NAMEc� PRIMARY PHONE
OWNER ��2.Dc4L aY bJvM S
r -+t000 V�StMc.9" ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
cNe.E SPw►�k.t 4 �)c. 4.(..F._?:,A44.4.0v3 (Zss ) 8v -0094
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
tU %4 l3oitvt+ ST 41.0u 51)MA/kit- i44 "390 ( )
CITY OF FEDERAL WAY BUSINESS.LICENSE NUMBER EXPIRATION DATE FAX NUMBER
Zo-05- 1001.33 ®6 t. (1.3 ) 8u, - 103 3
C=:27COPY of card oquirod CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
::;::::::each appllcatlou bR S 9 $RS gy uE 0 tRE,S PK.AlK.t.ri5•
)Z(10 g0C. .cow.
APPLICANT COMPANY NAME ,- APPLICANT NAME OFFICE PHONE
a-vh,E ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect o Tenant ❑Agent ❑ Other ( ) -
PROJECT NAMEPRIMARY PHONE E-MAIL ADDRESS
CONTACT V� - Bk(441.454.-, ( t ) 1924 - 00 99
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
N DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ Ze l i 500 4.2 D// S a 0
SPRINKLERED BUILDING? 'YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? RYES 0 NO
WATER SERVICE PROVIDER XLAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
' , ,, • PROJECT FLOOR AREAS _,
` AREA DES• ION 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 PROPOSED TOTAL TOTAL EXISTING Sr TOTAL PROPOSED SF TOTAL Sr
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
• FIXTURES
Indicate number of each type of fixture 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 sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(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. /
NAME/TITLE '/POf 0Qks2Perl 6t*J5 DATE )vl I Joi
ignature) (Title)
RELATIONSHIP 0 PROJECT ❑ Owner ❑ Agent Contractor ❑ Architect El Other
❑NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? ❑YES ❑NO UP/SEPA/SU? ❑YES ❑NO
PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100—January 1,2007 Page 2 of 4 k\Handouts\Permit Application