06-104070 RECEIV• •
cm orA AUG 1 4 2006 12 L. — —4— O—r _LL �6
Federal Way PERMIT
CUNENTS �/ SF MF CO ME EL PL DE EN
33325OMM8TMAVITDEVELOPMENUESOUTH•P0EB DIId OF FEDER L
FEDERAL WAY WA 98063-9 71 8 BUILDING DA LI CATI ON
253-835-2607•FAX 253-835-2609 /
www.cltuoffederalwal,com =s --
The ollowin• is re.uired in ormation-an incom•lete a..lication will not be acce•ted. Please •rint le•ibl (in ink)or t j•e.
• PROPERTY INFORMATION
SITE ADDRESS 3 53/461 / VC 5Lk-I' ex,t a( \A./at
SO()
3 SUITE/UNIT#
A (J L
`�
ASSESSOR'S TAX/PARCEL# ( 0 l 0 2 S LOT SIZE(sj)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page far lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 'FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only) �/
+`? At4L+rYY\St1$1 tiY>. 1 I. ✓' t . i Q �Sh✓\& -W�. . c11� (&+-4
rC
,( t/� {�� L t } l —
PROJECT NAME(Name of Business or Owner Last Name) ` �C I Gl '� �� 1 i�A I �I �c te✓ �I 1 I�)r` 111
�
PEOPLE INFORMATION
PROPERTY NAME ScRIMARY P ONE /}f;r
OWNER Meth ,AJL (.��tLi;\ c7 -tp._ot't t �f ({;7 �)i (f�') - -)se'lJ
MAILING ADDRESS CITY,STATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
t Lt - l2- 14
'�_/ly�,�(t l'.�'Y't / �:�rY,��1 k c C�v v� v�E C¢� (26" ) Ll�I( 1
(
U' h." ��4'�AA •i L.; - CELL PHONE
-
MAILING ADDRESS car,
TE.ZIP
CITY OF FEDERAL WAY BUSINESS LICENSE NUM REXPIRATION DATE FAX NUMBER
1 `l—R 3 - t C) 3 3 (€ — B°`11,42 l2 / 3i ( ) -
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
rLL. € e 0 '2- -76K- 01 / 12_ 'fir>
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE_
5 mpte,cC'�rii`y'� cx ' 4<cttk O•%Rear (L3-)24f - t 100
MAILING ADDRESS Avt CrIY,STATE,ZIP `" CELL PHONE
tin,
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑Tenant ❑Agent /Other(Describe)SLt 0 CO i ltr`C`C.tZh (2(Lc) - ()i)
CONTACT {U/ PRIMARY PIjONE 4 E-MAIL ADDRES
-t- k ei�i-€Gi <Y �, � �cCzv��, E��(
at,
lr�) itt (u�� iL ,-etw-�� e; i .Gerr✓�
LENDER , p S ' of&ln,/`�d'rst t(an tat * NAME
TI� 11 Pile fdfue exceeds'",$8,000 1 .7)1
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
,�1]
• DETAILED BUILDING INFORMATION
EXISTING USE Niyl PROPOSED USE �� C_G:.E �Vl IP7U;^� Cin1p e,
666 p7_l.._ �Y , Co l v""
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK
SPRINKLERED BUILDING? ❑ YES 0 N FIRE RESSION SYSTEM PROPOSED/RESU D? YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WE L-1(1/4•72."+'-1,1
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ 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❑
EXISTING PROPOSED TOTAL g'a`s'�O'tA.87�t"STTi a 6F 4 h''CD'r'N.PROPOSED EP E '�'O'4'1L Ario. '''''''I,
NUMBER OF FLOORS � v ,`
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL 1" ) (` 2
Value of Mechanical Work $ ,2-��LX ,UV
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/ShowerComt,o) 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 Inc 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. i
I ) � w
, ,I. t �I ,
NAME/TITLE ` l �."\��C`� Jt L'1.1 DATE t3
(Signatur) (Title) / t r {-�;
RELATIONSHIP TO PROJECT 0 Owner ❑Agent 0 Contractor ❑ Architect j l Other,71A )(I)'\I 't
47‘<eas
NE -:-Si.„( "."ADDITION 3 ci 'F i'$IRATION a REPAIR". a TENANT IMPROVEMENT,
tiIl.D+ G:SIIEI,I ONLY?,) :`Nrit3 t NO : BASIC PLA I?' a YES a NO
ZONING DESIGNATION` • ..r; 1.,:f."-- CH4 NGE`OI+'i.mt'i q a YES a NO
-.3431:,,P,PRE6S`REgUIRE1?4 :ti"10E$4. ri'NO" '4'''''' V4/SUj2' a YES .. ;a NO
P ' QT'S la YES a NO . DEl I P* ' NEQbIREDr:; a YES ';,.=a NO
Bulletin#100-January 1,2006 Page 2 of 4 k\Handouts\Permit Application