05-103860 r :.
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Federal
Federal Way PERMIT G 2O MF CO ME EL PL DE EN 1'
COMMUNITY DEVELOPMENT SERVICES r� O
3332FEDERAAVENUE SOUTH 980639718 9718 APPLI CATI Ol wA
FEDERAL WAY,WA 98063-9718
253-835-2607•FAX 253-835-2609 F FY
luwm.cituaffederalwau.coin BUlLD1NG DE*
The following is re,uired i ormation-an incom.lete a,,lication will not be acce.ted. Please .rint legibly(in ink)or ty.•.
,• PROPERTY INFORMATION
SITE ADDRESS G 1 CI( (1ef i (i . 5, SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 2_ 9 2.- I 0 4 - 1 ( ) L; LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) Tex (. fV\-'._ �-VA, \ t
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL _
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING�1 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) , `
.a-- -t If-\LLA i'.It i h7-1.- Gf• c - f 2$- V:?-:N-4--.11-
1_, 5 /<[ 1 l�1
PROJECT NAME(Name of Business or Owner Last Name) 22d( . �a,, t / .
El PEOPLE INFORMATION
PROPERTY NAME
Ey� PRIMARY PHONE
OWNER FL i-ti l`,l_._ \J(�\-( Sc`-FtML_ _&\ST(tic T 3 ) -
MAILING ADDRESS CITY,STATE,ZIP
tach 5, 32_0.,�i FL-Ni fit_ WP-( 1,JA `l,0033
CONTRACTOR COMPANY NAME �' OFFICE PHONE
-r-�.a 7�: AL (4.= .J 451 - c)cis
MAILING ADDRESS Cr!'!,STATE,ZIP CELL PHONE
(4Q5 (3L� ANIE.,.� -71111111..0.�;..---1. ).r740E= W A cl SCF.- ( ) -
CITY OF FEDERAL WAY BUSINESS L .- a V•IRATION DATE FAX NUMBER
(T1 — - / / (425)4G 1 - to3z-_
CONTRACTOR'S RE TION NUMBER(copy of card required with each application) EXPIRATION DATE
T . _ L c 02 �, r3 c_ , / /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
fl`(t�)g n iC5 �T�i, �‘XtE. c_Ot-LC�.1S (2.53) SS39 �7 9 '
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
P.0. 54 38 j r- Lha, -i aC, , (25 i )2S �•�O)
%• -) ;� a _ /A RELATIONSHIP TO PROJECT FAX NUMBER
K 11J\rl `AAII"„ll,/j ❑ Architect ❑Tenant 0 Agent Other(Describe)SJFC�TRh�AC-.10(-- (2-5'3) S3'i -`�c{
CONTACT h NAME PRIMARY PHONE E-MAIL ADDRESS
( '//a CEVi=—t C_JLLL�c' (253 )'2- -91 94 C Jam..- 10 Fb -t.!t,.1.con1
LENDER // pt (j $ f1(IQi # tli'lltgLitll4 NAME
required(�t'pnnect value exceeds$5rOi0 , L1�12�1 L tri:( c t t v C cTL -E C�
MAILING ADDRESS CITY,STATE,ZIP PHONE
101 . 33 )1" F,= ntet_ way( �P ` (251) -
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE /_ T
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK / / 47` / 6,-).
SPRINKLERED BUILDING? o YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUI D? 0 YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
r •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL
TO :EXISTING ex TOTAL PROPOSED SE 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 $
AIR HANDLING UNITS EVAPORATIVE 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/Shower Combo) SHOWERS WATER CLOSETS trouet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks) 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.
NAME/TITLE 1.1 DATE V - 7 c
f0+Signature) (Mlle)
RELATIONSHIP TO PR r ECT ❑ Owner o Agent o Contractor ❑ Architect Othe$U& C (tJ(L_
VOW TCIr<IlS) <3i1 ' 'i
a NEW t AI)DITI4N €ALII:RA1tION li REPAIR o TENANT'IMPRO NT
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x01 ''€I. ESIC,I; `ICON NCHANGE OF Ute? T'ICES I NO
NSW 3I3� 'd� a'I''I a k�TO /SEA#:SU?
TTEI�LC►T 3 I a NC> DEMO REQWRE 17 €a NO
Bulletin#100-January 7,2005 Page 2 of 4 k\Handouts\Permit Application