05-102469 A'
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OF REEL•°:. S _ — J_0_Imo- �L
Federal Way PERMIT
COMMUNI,YDEVELOPMENT SERWCEs f SF MF CO ME EL PL DE EN' F`-
33325 8TH AVENUE SOUTH•PO BOX 9718 '
FEDERAL WAY,WA 98063-9718 APPLICATION TD
/ /
253-835-2607•FAX 253-835-2609
www.dtuoffederalway.com ,i Y OF FEDEH, L WAY
BUILDING DEPT.
The ollowi • is re,uired in orntation-an inco •lete a••lication will not be acce•ted. Please •tint le•ibl in or • .
■ PROPERTY INFORMATION
SITE ADDRESS 2 t Z$ 3 z--.... A VL Ss SiL,-t- A SUITE/UNIT# A
ASSESSOR'S TAX/PARCEL# - — _ LOT SIZE(sJ)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal desutption)
■ PROJECT INFORMATION '
-
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 1314IRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
At-e Cr?Z/e l.ccd--X: ,,071//‘'0/7-, ,17zf-, /AM/77t --'
PROJECT NAME(Name of Business or Owner Last Name) 4E-A1/277m1 6- •rar ezub A.,—e,
PEOPLE INFORMATION •. '...,
PROPERTY NAME �/' t l' PRIPHONE L y
OWNER E.C� d 0(2 l O Xi[.�a1 r- I� l� [ MARY
(L: ) XS,2N-& O()
1 F�7Y1 ( MAILING ADD r CITY,STATE,ZIP
Ka Tr— ( F-03)
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
'Z4'/> /mo i-C /e�=7i`7,/ (ev) ) 1-7 -20.. Z'
MAILING ADDRESS CITY,STATE,ZIP gD 329 CELL PHONE
//e....,2 f Cf2/4//>*'R /2-,3 /</R4-1) K 4/4ee Fac,/.. 41,/,4 (zs ) &to -/2,
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
c-L. -, - ge4 SQL L -7-Bi /2 / / /0 (z>3 ) g -7 -z3 12
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
APPLICANT COMPANY NAME APPLICANT NAME/ OFFICE PHONE
L it�ic-7'i4 4 A l�iiL[='"LLL / `7.'-),r //,..4..sTxe.--, ( 2 7 3) IS'S 1 - 2 ca r
MAILING ADDRESS CITY,STATE,ZIP , - CELL PHONE
lie t Cr, i0�x .eo ,.-' <‘ /4/ ,.4 /t/4 ( '72 k zc : -iz/i
RELATIONSHIP TO PROJECT - FAX NUMBER
0 Architect 0 Tenant 0 Agent ¢—her(Describe4v77 -r,-r/L_ ( 2-Y3) rl5 1 - 2 12_
_
CONTACT NAME / PRIMARY PHONE E-MAIL ADDRESS
,% Th //_Vic 2fi, ex, ( ) é'l - 121-.? /te -cc.e L/rt•<<;._.,
LENDER ' '€ n e a° NAME
4 ::.°°7`‘:.!4':41
MAILING ADDRESS CITY,STATE,ZIP
• . . , ■ DETAILED BUILDING INFORMATION . ,
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $irAfr
j0,kerc9 .0-c.,
SPRINKLERED BUILDING? o YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
1
•
�i •, ..., ,PROJECT FLOOR AREAS ti_. �,
. ,
._ ".
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ. FT. SQ. FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
•
ADDITIONAL FLOORS(DESCRIBE)
•
DECK(COVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS Eastuto PROPOSED TOTAL Tow,kJ¢arncas'r 3fI #tor,v.PROPosrosr s orv:er Pr
**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 $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commorcizi) WOOD STOVES
BOILERS FIREPLACE INSERTS , RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower combo) SHOWERS WATER CLOSETS trotter . MISC(Describe)
DISHWASHERS SINKSDRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(sazhroom 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 o cern qhd employees, upon the accuracy of the information supplied to the city as a part of
this application. `
NAME/TITLE ``5>
-c-„�G! ` L � 0 DATE S- Z S- CJ
(Signature (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent Itontractor 0 Architect 0 Other
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Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application