06-105797 • RECEIVED• •
CITY OF CL 5 79
Federal WaY0V 0 9 2006
PERMIT SF MF CO IE EL PL DE EN FP
COMMUNITY DEVELOPMENT SERVICES
333253D8 AVENUE SOUO I.08,1'�S7 DE RAL W ��
FEDERAL WAY,WA 9806 .971'$DING DEPT. �PPLI CATI ON
253835-2607•FAX 253-8moillut
www.cttuorrecieralwau.com
The following is required information-an incomplete application will not be accepted. P ease print legibly tin ink)or type.
1111 PROPERTY INFORMATION
SITE ADDRESS 3,2(Nil 3.? 4w-- S SUITE/UNIT#340.5 - t[3
ASSESSOR'S TAX/PARCEL# 21 S X171 e S - O 8 3 6 LOT SIZE(sJ)
LEGAL DESCRIPTION(e.g.Acme Estates.Lot 1) £T 401,1,5 lIZO� � flQK //� G /.74K5P
(Attach separate page Jor lengthy!eget!descriptioO
■ PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ® MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL 0 ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onit))
NSr,-i %a�) z s-�o,/ qM Two 6) /o-roh/ �,�s/E-/Ecreie 7ew l/,arrs
Lr'�rN �V '/5 4. /If4 �/.. mss ,1.`-0 r�✓,sd i/477 � �3 ,dip/.t/
PROJECT NAME(Name of Business or Owner Last Name) ��✓`1411,/�.5 i ' 5 /i/ �/ G -ga26 '"S1 LG
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER T �.4,1pvs /E17R,4c6 JAG ( ) -
MAILING ADDRESS CITY.STATE,ZIP
/6yer 3OvrHe,c062 ?Kw y So' 'Kw/1-4- , W..4 75-7 srir
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
VA,/// 2 L Ae/M.✓,e...4/ cE U,�i lieerd 0/4t � ('4/75) 58.5 -9/et, A
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
gro/ ,e0 ,eeoifar✓J, /0 P - ' ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
0 - 02 -- / 0 Z S Y - B L /2 / 3/ /06 (4'75) 8-/ -687
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
QLMIJF-
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
VW/V6ris4-t AcH4'41c�� S�,Ziie& s.�� , �l�V ei./tte.( 997-5) 88.5 - 9/°°
MAILING ADDRESS CITY,STATE.ZIP CELL PHONE
gr'/ Gf//61�u,5- ,�o /7�,�Io,�O, to- f8`GS,z ( )
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑ Tenant 0 Agent iz Other(Describe)Cao/Mitt7-o,2. _ I 1/275 )88/ -6/B7
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
r/u£z (W/ -5 ) ge. -YI D 5m gut 0,,vi-AIL`c,C, 4'1
LENDER Per RCW-19.2?.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY.STATE,ZIP PHONE
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE -
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ 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❑
EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
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
Value of Mechanical Work $ 4715 '
1 AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBgS FANS HOODS(Commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES y MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS 677j jf-/,�' 6 ,'C '6'F Tee
DUCTS / GAS PIPE OUTLETS F9C ,f6 73
PLUMBING
BATHTUBS(or Pub/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 .ny claim(including costs, expenses, and attorneys'fees incurred in the investigation and defense of
such claim),which may be made by a . - ,including the undersigned,and filed against the City of Federal Way,but only where such claim
arises out of the reliance of the ci _{Inc .0 ing its officers and employees, upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE it �I -/Iv; 7_ -11./• /Z DATE /#1
(Signature) (Title)
RELATIONSHIP PROJECT o Owner ❑ Agent J&Contractor ❑ Architect 0 Other
FOR OFFICE USE ONLY
o NEW o ADDITION ❑ALTERATION a REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES ❑NO
NEW ADDRESS REQUIRED? o YES ❑NO UP/SEPA/SU? a YES o NO
PLATTED LOT? -- a YES ❑NO DEMO PERMIT REQUIRED? o YES ❑NO
Bulletin#100—January 1,2006 Page 2 of 4 k\Handouts\Permit Application