06-104068 „s„,, Y RECEIQ •
CITY OF „,,%.,
5ft: / / ‘ - J V _a 6 V
Federal Way AUG 1 4 2006 PERMIT SF MF CO ME EL PL DE EN
COMMUNITY DEVELOPMENTSERVICES
SF
333258r"AVENUE STH• WI OEDER LIGATION
FEDERAL WAY.WO AU 98063-9POBF FTo
253-835-2607•FAX 253-835-2609 BUILDING
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www.cittiolfederalwaur.corn ••
The ollowin• is re•uired in ormation-an incom•lete a• •lication will not be acce•ted. Please •rint le•ibl (in ink)or ty•-.
t/� • PROPERTY INFORMATIONp� ib �( /� O
SITE ADDRESS 35eiC1ci tl.p�'" /\Ve. , 5C�t.t.th , ve era[ "vN v003SUITE/UNIT# PonJO7L-'
ASSESSOR'S TAX/PARCEL# a ”L 1 U Li - l D 2 5 LOT SIZE(4) �bn
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING ❑ MECHANICAL
/
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 16 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
I A.cwv► \SDom;-X-WY'>, 1 t) ✓ -t,lv.�, k (Sh 1,t, -vv\. Jr F(%-
PROJECT NAME(Name of Business or Owner Last Name) 1 U l/1 �� 1 L��I��C ��✓ �i ti Ur\ w r
'e • PEOPLE INFORMATION
PROPERTY NAME PRIMARY P O E
OWNER F � l/oGL.t . Ct 01-10 est-. (6301
-VOID
MAILING ADDRESS TA
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
F v bA,c,fYl b m pl..k4ce-iv; YN-v�es._ ' (263) (Al2( '7lS 1
MAILING ADDRESS CITY,STATE,ZIP PHONE
31 I o 7 12, 't AVC S. F.eJJk t l3&4 LA ( ) -
1 OF FEDERAL —WAY BUSINESS LICENSE;VUM$$R—B ' EXPIRATION DATE FAX NUMBER
Ci-
CONTRACTORS REGISTRATION NUMBER(copy of card required with each appliiccation) lr EXPIRATION DATE
r L< t E 1- 0 21 i3 .--- 01 / 12 /201
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
5 i irn p t✓ eiYi w✓t_e....e 4KG1Ltiai D'Re&r (LDL )24(J - fi e'
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
C ,w (o fkvt. C, • v (be, So.6.. _ ( 0S• ( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect 0 Tenant 0 Agent /Other(Describe)S Co ntraCfic' (2O& )2c1 1 - r...-,(-)C
CONTACT N E T Ur PRIMARY PHONE E-MAIL ADDRESS
`�4f�1: Rea �.,a ei�; �(3 )'�a I �( F-0-,rteye-0 teVi-,Ctrig ,
LENDER per RCW 19.27.095. Lender information is NAME
required if project value exceeds$5,000 (J
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION /t tt
EXISTING USE I`)lPROPOSED USE eCSA-A-4--LL'l i 06 I Pr'-a 1 CLG��G
666 `� (/� w Q ,
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK 1.... --(2 r ,dr-0
SPRINKLERED BUILDING? 0 YES 0 N FIRE,SUPPRESSION SYSTEM PROPOSED/RESU D? ia YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN IGHLINE ❑ TACOMA 0 PRIVATE(WE CUL Ci2.A✓1/1
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
I► • III
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❑
EXISTING PROPOSED TOTAL 'YOTAt.EXISTING SE,c, 'S'LITAf.PROPOSER SP :TOTAL 8F '.
NUMBER OF FLOORS
**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 1 j �� n,� t7
Value of Mechanical Work $ 2-14, 3 W
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(Commeretall WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS ,� FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING etQf P<t- Si
BATHTUBS(orTub/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.
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NAME/TITLE w\11(% 11 M,( DATE r
(Si ( (Title) �'1/ 1,,,/(Il
RELATIONSHIP TO PROJECT ❑ Owner ❑Agent ❑ Contractor 0 Architect �7p Other KJ NY
ZIZe
FOR OFFICE USE O t
a NEW ADDITION o ALTERATION ❑REPAIR i TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES ❑NO BASIC PLAN? a YES ;Q:NO
ZONINGDESIGNATION CHANGE OF USE? n YES i NO
NEW ADDRESS REQUIRED? a YES a NO ' UP/SEPA/SU? a YES I:1 tI NO
1 PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES „ a NO
Bulletin#100-January 1,2006 Page 2 of 4 k\Handouts\Permit Application