09-103085 RECEIV 40 •
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ur~ot AUG I. u 7 "
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Federal way '' s PERMIT
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE EN FP
33325 FEDERAL
UE WAY,{2��p6-9
FEDERAL VI2 FEDERALII CATION m
/ /253-835-2607•FAX 253-835-2609 CDS /
www.cttjotPedentlwaat.com
The oliowin• is r••uired in ormation-an incom.lete a••lication will not be acce n ted. Please .rint le+ibl (in ink)or .
• PROPERTY^ INFORMATION
ADDRESS` 3Z( -6'32t�b ''/(��*I'�Ci- s . SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 2 f 5-1- (0 5-- 0 C] v LOT SIZE(sfi
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal descriptloN
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING)E FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu) \\
yNaT 11 AL Dettle/C-12S (N - fit me C./374/0 a;\-4-7.-
-rm.,.
iT=. tic
PROJECT NAME(Name of Business or Owner Last Name) 111a' jt I . _ 1'S'
•
• PEOPLE INFORMATION
PROPERTY NAME 1 u PRIMARY PHONE
[[���21
OWNER �. 415 (2S3)921 6/
MAILIN ADD CITY,STATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Ca
WPD1ts3
(La )j' -A `
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MAILING ADDRESS C1Y,STATE,ZIP CELL PHONE
1�INS/ Ani
. IaveS ,,, Eejv - nO111 OF FEDERAL LICENSE NUEXPIRATION
FAX NUMBER
_- -0 -l0 2 1 ' B L (Z /It / 01 ( ) -
G� 1/ C` R'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
V/ / /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
MAILINGo ikleit v'it'°( i i C+0►(;�/Prt (4�)Z71'. - .11g04) �YIU9'7T1ick. At 5, CITY ZIP Vii)- Z �J, (E PHONE)4J J --Y 6 Si
RELATIONSHIP TO PROJECT if FAX NUMBER
❑Architect 0 Tenant Agent ❑ Other(Describe) ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
( ) -
LENDER
ply. ;�z �. a . �\ NAME
MAILING ADDRESS CITY,STATE.ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
Cir
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 7 7 7
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
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 D
NUMBER OF FLOORS EXISTING PROPOSED Toru
y 4
**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
Value of Mechanical Work $
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 11 b/shower Combo) SHOWERS WATER CLOSElb Foaet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Svcs) 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. It 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 4 (�.,�09
DATE /
ignature) trttie)
RELATIONSHIP 0 ROJECT ❑Owner ❑Agent Contractor 0 Architect o Other
1:17 77::: .71;r\P' 71/1 ,./0'
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Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application