07-102751 ` CITY OF A.
-7 7 Si
Federal Way MAY 2 n'37 — — L — — —
COMMUNITY DEVELOPMENT SERVICES eftAt`'`I'''' PERMIT SF MF CO ME EL PL DE E FP
33325 8Th AVENUE SOUTH•RI Bw�,.±r�c'AP P LI C ATI O N �°
FEDERAL WAY.WA 98063•B7I8 11�DlIvV DL
253-835-2607•FAX 253-835-260 �J / /
ww w.citsotlederalway.com
The ollowin• is re.wired in ormation-an incom s lete a..lication will not be acce.ted. Please .rint les ibl (in ink)or t( se.
) �
IN PROPERTY INFORMATION
+
SITE ADDRESS 3 2 12S, `L t> " I t/ S • SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sJ)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING V FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detaileddescription of work included on this permit onlu)
Tfici-11 4; DEVtZe S 6 Ni: ii i -FL /�.- -r
PROJECT NAME(Name of Business or Owner Last Name) W ev e// / /pP &/ il/B 'a,,„
• PEOPLE INFORMATION
PROPERTY NAME�V/ €V 1 f^ S� PRIMARY PHONE�.7
OWNER E preo (-2,3 )Hl 49 943S-
MAILING
ADD CITY,STATE,ZIP
32.12-c 3 6 Pkv-E- S", i -il- ( (A)A g8003
CONTRACTO COMPANY NAME APPLICANT NAME OFFICE PHONE
NCv&Or - Ta,tki lelor fhoe'(. �%aso (q1 )272, -l -Sb
LING ADDRESS CITY,STATE,ZIP CELL PHONE
OL c 5.11471VCfc ,4-vE S' (Er svc•.)e , f pos7 ( ) -
IIY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER -
)
d/ICONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
C ) J1 E TL ? a `[ b � i / (Q,- /O9
APPL - .• CO ANY NAME APPLICANT NAME OFFICE PHONE
fC4�� 'S ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑ Tenant o Agent ❑ Other(Describe) ( ) -
CONTACTNAME PRIMARY PHONE E-MAIL ADDRESS
ti�rL �� �� t (t(2( 77Z- - 2-7 )
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE h
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ lir toO, GU
SPRINKLERED BUILDING? ❑ YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER a LAKEHAVEN a HIGHLINE a TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAKEHAVEN a HIGHLINE ❑ PRIVATE(SEPTIC)
.. , 0 i
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❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixhtre 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(comme e at) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tu rover Combo( SHOWERS WATER CLOSETS(Toilet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAYS(Bathroom Stoke) 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. -7
NAME/TITLE `�� / - DATE 2 i ~0' /
(Signature) Mlle)
RELATIONSHIP T. PROJECT ❑ Owner o Agent ›(Contractor ❑ Architect o Other
FOR OFFICE USE ONLY
❑NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Pernvt Application