05-104376 RECEIV
. . .. • �,
Fed a 2 2005 --} j D/3 �
�' U� PERMIT
COMMUNFIYDEVELOPMENTSERVICES SF MF CO ME EL PL DE EN
?15-1)
33325 SIN AVENUE SOUTH•PO BOX 9718 FEDERAL
253 J607 FAX45398°63-9718
576'09rvILDING DEFPPLICATIO N TO 1 / -
Juww.cif goirederal wa y.pm
The oilowi • is re,uired in orrnation-an inco •tete a..lication will not be acce•ted. Please •rint le•ibl in in or
•■ PROPERTY INFORMATION
SITE ,��.ADDRESS `J I i LO Ave', 5UL�-E'� 1 led cyzi ( Vtio wA G�%SUITE/UNIT 1t ' `3DI SNj
ici
ASSESSOR'S TAX/PARCEL -
LOT SIZE(4)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL _
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING H FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onto)
Met s► , Remove, Ni, t�i qakil� .- d:evi e:�,smo► ,pu, r_f Al f
On. to:�I�, � .
P in 66m 14-«O L11A. � pH c , ovv rel•vsj d j-vi ,off
yio tp rata-tat ►(`e 'e!ri1:ex,'3.
PROJECT NAME(Name of Business or Owner Last Name) Kcal aearnt r (-k hGc.hob i(C-►Gssrtorn Add(1 foi1j)
IIS PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONEg
OWNER Fed Cal I a. 156kop) l)iSf- " (a53 r ,( - -$`-
MAILING ADDRESS CITY,STATE,ZIP
i0(A, s04_,Lto, Sao '' fecLi. wi`ui klA 0415u03
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
/ t(emter Sys�e�•5 0gPiex(i,'lr<v-ea(,Kafh (Rear (�2i ).�L:j - '(334..
J G is a MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
1'v ✓'' I i, tat;X ,),$‘60._. 4,rtictAkct 1Ai( .. e to.z j ( ) -
OS
f I I,`�.,( , Y OF FXDERAI.WAY Rrfe ,.
,Nao�ra.,oc.r�va'pn,4 EXPIRATION DATE FAX NUMBER
,✓✓ �f C TU.-0C 'k)11 t't4 - 13 / / ( ) -
oto CONTRACTORS REGISTRATION NUMBER(copy of card egnired with each application) EXPIRATION DATE
1--) R )J\ z 5 9.-to 3 }� i / L- i /P,00/p
APPLICANT COMPANY NAME APPLICANT NAM
SY�r14p1(;xerinlnClt L4Th 0'(Car OFFICE PHONE -i14(o
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE ry- Zot,wo.)4bt%
(1521 Ion Avg. S. *I1)1) atH,e, wA- gSlo' ( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑Tenant Agent :tii Other(Describe)S b e-Of Y' (ZOLp) AL1 I - 150C
CONTACT 6 i D I RC) f PRIMARY PHONE
E-MAIL ADDRESS
( ) .)\"A - `��� Kl4 ei1e
Oint e e00)
LENDER
1, ,d:., .i.-,a •. ::{. r.. f,r; ,. .fs�,ta NAME
MAILING ADDRESS CITY,STATE,ZIP
■ DETAILED BUILDING INFORIIIATION
EXISTING USE x hoof t?ARCQ.h (n/\ PROPOSED USE 4)(4100 I/ed t C ;65Yj,
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ ']Gj�(j,co,
SPRINKLERED BUILDING? ❑YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN a HIGHLINE a TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN a HIGHLINE ❑ PRIVATE(SEPTIC)
f^ ;,)..
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 0 CARPORT❑
magma PROPOS= Taro qi .,,j �aXi?R ixfar l...
NUMBER OF FLOORS f
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offacture 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(cam menus 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(Tao MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES _ URINALS HOSE BIBBS
LAVS(e thmeesus* 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.t,/ n _ n A
NAME/TITLE ' a f i ��1"x-1 C?J't- Yl p L-UX I I At(l iw(- ( )°' `0 ' t' DATE S' L'5
(Signature) J (Nile)
RELATIONSHIP TO PROJECT 0 Owner ®Agent 0 Contractor 0 Architect 0 Other ' �'
P?I'N tae)cc'(i i. aE t Di;A!r'(s);:. 'a rte•i . .i' r, e z.Ytl�; e�1aV
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Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Pc mit Application