06-104071 RECEIVED
RECEIV�D
cm or A 1 4 2006 iD� 6 H
Federal Way AUG1 A ���c PERM I I
COMMUNrIYDEVELOPMENT SERVICES Cn-YOF FEDERAL A� SF MF CO ME EL PL DE EN
WAY
33325 gm AVENUE SOUTH•PO BOX 9718
2FE53D8E3RAL
526W•Y.FAXWA 1953808 6335-9276108p ITv OF FEDErTRLT CA,lu%tN
•
www,ctttollederatwalLcorn BUILDING DEPT.
The ollowin• is re•uired in ormation-an incom.lete a..lication will not be acce•ted. Please •rint le•ibl (in ink)or •e.
fn1 I� PROPER(T-�Y INFORMATION
�/d` / fin/ (�
SITE ADDRESS 3 3"t CI c1 1 l�' ` I (5 . ;.. CA-t r I 1G�l L t,ra t at 'OO 3 SUITE/UNIT# t o f-\)ta' e
HiYiq
ASSESSOR'S TAX/PARCEL# l� `( ' ( 0 L� - l n 2- s LOT SIZE(sfi
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate pagef length]legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT ❑BUILDING 0 PLUMBING 0 MECHANICAL
❑ DEMOLITION 0 ELECTRICAL 0 ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
1-t ' Ata.4-wrSv -Y>. • t,}l✓ tar. z � ISh�'�/ . 4v ' . . �Y '.
�4) /1 t'(l I!1 ..LY) G4l tab. \ , �) lf
PROJECT NAME(Name of Business or Owner Last Name) 1 � C1l r LC-( i I i) Pe!Al'Abi tt✓ I£I f(i1)r\ 172 � v
MI PEOPLE INFORMATION
PROPERTY NAME PRIMARY PONE
OWNER Fe-C 'Z.(\J 1/ (Llam\ �' a-OL-'1( ( �j ' (6^1('�:))(4LfC) - C'J
MAILING ADDRESS CITY,STATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
MAILING ADDRESS CITY STATE.ZIPC` CELL PHONE
'31 0 7 l 2 t Avt, S. F.� 1i3azi U A r ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUM RBEXPIRATION DATE FAX NUMBER
1V'1-d1 3 - I 0 3 3 - L� (2 / 3 j / off
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
r LA L L. E i- 0 2 7 3 K— 01 / ' C'V
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE_
4<&f/l, C'iRea_r (LCA`)2 (I - 0100
MAILING ADDRESS CITY,� STATE,ZIP C„ CELL PHONE
(( y (D;l'(/ f�talt, C� i� (L(�` a ttL� C fit- Ct;<<1\gg1C S ( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect ❑Tenant ❑Agent /Other(Describe)5G (.�l)frI`e (l C't[ )ZC ( {�J G•C`
CONTACT NAME /( �v� f-vY PRIMARY PHONE p / E-MAIL ADDR1 Sys
Ccf(<�i l'ReLI V� y'n.la�tj(�Z✓ttn E �(ti7y�) �1 [��0� 1��'• VG1"�{C'L`twr •4E"✓V-
LENDER • g
iwteYtdCf"iftfGrfl}at,0 NAME
prat value arceeds' S•��QO I'- 1
MAILING ADDRESS CITY,STATE,ZIP PHONE
1 ■ DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE e k— I DY) I CLCL r1-t5--
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK C9\ _ `r ' C`, '/
SPRINKLERED BUILDING? ❑ YES ❑ N FIRE RESSION SYSTEM PROPOSED/REQU D? YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA 0 PRIVATE(WE at CL-3'4,71,--1
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC) �a
• 411
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 TOTALTOTALEXLSTING SC '{'OY'AL PROPOED SSP y TO'AL}P
NUMBER OF FLOORS 0r � ;tom
**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 $ u 2-�'�jtJ v`'
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 torThb/Shower combo) SHOWERS WATER CLOSETS(Toilet) 1 MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Soaks) 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 ` C4 / C /l lX ., R4 ),f2f DATE 1"---) (..l,']J
(Signatur) (Title)
' .
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent 0 Contractor 0 Architect ly,] Other�71A.O.(1t1 ` 4 ,�U
a NEW ;0 • ® .REPAIR o TENANT IMPROVEMENT
BUILDING SHELL Ofiet'?i `' A' `ti YES NO BASIC i'Ltirvt a YES p NO
ZONING DESIGNATION, p . ,.: •'/ x IliAI�OE{ >1t E a YES d NO
NEW ADDRESS REQUIRED? o:YESi`4 I? 50 ipiiik U �fial a YESn NO
PI:ATTED LOT? a"YES w E 1:z " OE,EVt )Ettfit,D? a YES n NO
Bulletin#100—January 1,2006 Page 2 of 4 k\Handouts\Perinit Application