06-104072 RECEIVIF) •
CITY Of AUG 1 4 2006 0 7 2
Federal Way FEDERAL WDER1VIIT ` - - - -
COMMUNITY DEVELOPMENT SERVICES-"Y OF FE SF MF CO ME EL PL DE EN e
333258'71 AVENUE SOUTH•PO BOX 9718 LI CATI ON io
/
253-835-2607•FAX 253-835-2609
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www,dSoffederalwaq,carn '
The ollowin• is re.uired in ormation-an incom.lete a.•lication will not be acce•ted. Please ',int le•ibl (in ink)or p e.
t//�� MI PROPERTY INFORMATION /�,
SITE ADDRESS 3�`-1 C1 \.LprV�V'L , 5 C LCr h �C�/�d t ra k at. i SO J 3 SUITE/UNIT# re f\fd- '( ��I
ASSESSOR'S TAX/PARCEL# t' `- " ( 0 Li - l `/ Z 5 LOT SIZE(s-f) I� �`j b�
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page Jar lengthy legal descriptlun)
• PROJECT INFORMATION
TYPE OF PERMIT El BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING /FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide} detailed description of work included on this permit onlu)
ii A tC1--'C r A C--)Ci.(v`.-r-Yl, T 11 l✓ n *-'C'C t, 1 1 1✓G1 1:)t/&-4/1' �- 1Y- I«`i-4
f)I'>1 t-CL-V)L2 t�
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PROJECT NAME(Name of Business or Owner Last Name) 1 CO d b(1 0Ir (.ri lO t--1).A T/i,-l'>i(i:1-., "Bei It ar\ - 1 P
• PEOPLE INFORMATION
PROPERTY NAME -- PRIMARY PHONE
�c o L_C L`,( it `�- (67,r..-').,,14114-(7.) �
OWNER V�C'-C�F..,)Lt-�-.,� L1._:(Lt. I\ �� l � 7�L���
MAILING ADDRESS CITY,STATE,ZIP -
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PIIONE
1:-
t � .r�1 lief - (Cb/ i
3J�(.2)2� L't�lil` `t / �:m I]Lk ic.Cly t' y�.v�6,-( (IV'? )
MAILINGADDRESS ���+t CITY,S,,TATE.ZIP CCI11D, CELL PHONE
i Avic 4; -
CITY OF FEDERAL WAY BUSINESS LICENSE NUM R EXPIRATION DATE FAX NUMBER
1 -� 3 — i - B L� 12. / 3 / / O ( ) -
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
r' LA. L L. E •6 1- 0 i- -7 L3 K-- 01 / V7_,_ /2tr)%
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE_
5,: VI,A.p ts(CIvii,\_ (. 4 ttta O';RCC{ (lit--1240 - 42100
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
0 C5?-C (C ice` Avt-, C7 . fi t LtJ .cc C._ (_u (- r(SICi 6 ( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑Tenant 0 Agent /Other(Describe)(.. ) Ce l''tre C tz' ' (2Ctl.)ZLi 1 - fi)0 t'
CONTACT NAME f �vs•) (O( PRIMARY +/ E-MAIL ADDRESS
/1-"\c<,,4 ld C'F11 ar •')Af,.,fliP4Cl(" d-E'9( ?ID;Tit( - 14 6(;-', Ve,--e+ireL, yet2>✓k-r -t: "eln
LENDER IPer RCW-I9.27 095 Lender',infotnp&tignl fs NAME
r'equired-(f1rojeet value exceefde*OOO : N—"/i'
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE iv1/; PROPOSED USE (-)(k).-t-_G; . Dr) { (�o;-y)-6ID t(.. �'_t(ti-�,y4,1C-2.-^rl
K)1/1
6 `7 (4> be " '�.
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK _l_ (Lv
C E 0 TACOMA 0 PRIVATE(WE C ❑ N.-
SPRINKLERED BUILDING? 0 YES 0 N FIRE�T3PPRESSION SYSTEM PROPOSED/REQU D? �7 YES
WATER SERVICE PROVIDER 0 LAKEHAVEN HIGHLIN /`�„^- � GL's-• ✓^1 %�%
SEWER SERVICE PROVIDER 0 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(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
EXIBTINO PROPOSED TOTAL r{k4. ISO8,t7.-,,f i,„,'Lyk. OROP$O6! $`F�''^ h "'fOT),%7
NUMBER OF FLOORS "t '70',51... y ,, .,.. r, ,. _. -, ,�
**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 $ ,2-14) ,CV
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commereiai) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS 11` FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS "---.(
PLUMBING
BATHTUBS(or Tub/shower combo( SHOWERS WATER CLOSETS(Toilet) 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.
ff L
i ) Q i L/It,/`t 7
NAME/TITLE \✓ C1 ,J1 �� ,(1)'.t IAA, DATE is(y/
(Signatur) j (Title) i' ��,, /,,` Y'� /( '
TO PROJECT ❑ Owner o Agent ❑ Contractor 0 Architect X Other. 4.t Yt " .(Z1(-
RELATIONSHIP
# * �AA.PN o, a RE1 ° 4� "''''%''''� .' NANT IMPROVEMENT.
80:11 ' 1 a S a NO �< ------e‘,":11101:7--?4''1;4•S','
I - 4''•1 D YES 0
NO
s r a r e 9 pI?1® a YES a NO
m ® x. <'-;:,1,� to a ' S- `NO 4.Y E 4ittlOP 6t YES (25,NO
;'s .:YES`,o NO 'R y �v0� R'iMII "REQ fIREID? =- .,: ...: TO
Bulletin#100-January 1,2006 Page 2 of 4 k\Handouts\Permit Application