14-103399 4 aliNlik.. ReCEIVED • 0 _ ' ') 3 3 9 9 -
Patera!way PERMIT
COMMUMTYDEVELOPMENT SERVI UL - 9 02
SF MF CO ME EL PL DE EN FP •
33325 8TH AVENUE SOUTH•PO BOX 971$-,L
FEDERAL WAY,WA 9 � ' � •
� �� � � it/
• 253-835-2607•FAX 2538 '1.,•F FE. . . L I C AT I O N / /
unutu.atuo/Tederahuau.,• Ot;P, et' 1 AY
The following is required inj6rn ation—an incomplete application will not be accepted. Please print legibly(in ink)or type.
• ' - - PROPERTY INFORMATION
•
SITE ADDRESS-3 20 I g Z 3.-, P A V< .5 SUITE/UNIT#
( t _
ASSESSOR'S TAX/PARCEL# V V� t Z __ LOT SIZE(sj7 •
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal des,,piton)
■ PROJECT INFORMATION •
TYPE OF PERMIT 0 BUILDING 0 PLUMBING. 0 MECHANICAL
•
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING A FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of
t ofYf�work, included on this permit onluu)
'b
•to .. • .C. _I 41/, a' Y K/ G.L 1 LI AI 4 /h-1 I 5-1-,U'1?(�
11(o LA/ ((
7c P 4.,,t 2&u t)44.51"i L� X/a w c ....1 L i n/ G-- M''1 . .S10 /-10-1 N rcf"0,6£.5
£$ (i 1 .\/ G-- M .IV c 74 -0 LI— 5 i U l i Pi a Me L i C.)(/ ST/ n/ 6— 2-1-1 (/ S A J4
6,o < $u p Ip L 7- , £,ci s'f,A/c— 5 4In o i - .Q A / o LJ< . /=A PA No L---
PROJECT NAME(Name of Business or Owner Last Name) U ki /141 ci)/G L /N.,/G-l-i le 0c)Q l)D U i() C Li,til L
al PEOPLE INFORMATION
PROPERTY NAME I' PRIMARY PHONE
OWNER V w /)'VI lc.( 4— / (1(o ..i `4O2 !]ot�.Q G Li NIG.S (om ) 52o -5b(s,(,
MPU'&o)c ADDRESS Cl1 l 0 CITY, L (Al IS '44'455411 y (4)pN,0126--
CONTRACTOR COMPANY NAME SOLv�,/U1uS ARPLICANTNAME; OFFICE PHONE
. StiAW ), C41•4140,1610-17,- s'-c.t.,6'pi 1ia1.4.4a,R10 I<tJ. ki?.OSOA/ (V25)/'S7 - 7 r7do
MAILING AdiDRESS CITY,STATE,ZIP CELL PHONE •
270u 121 4.EIt12.)s 2,4. s1 f- z.,z B E.t,Lc 17//e_ wA c 8°QS ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
a.&_ o(, "lvGy qg -- 66131, 1Z13)111/ (1s)71.14 -o o&L/
CONTRACTOR'S REGISTRATION NUMBER EXPIRA.TIO DATE $-MAI`L A pij.�.SS�I G�^
ity
E G 51- Ai t c 5' `�' 7.57)11 2. 7 �'zu/,� 9i ,�(3en�J itv c,Co/l4't
APPLICANT t.:
A1PWCANT N Mi7 ) APLgO1if rt-725113-7
.700
-;::.3.;—.(..),„„1-.7,.;._;11:31,211
1r71G GRs
jc...2.61 2
- "Z i3 .L(. "(__k,C 005 C(ELLPHONE
-
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑ Tenant `f Agent ii'Other ( q2-5 71A - p o t 4/
PROJECTwPRIMARY HONE E-MAIL
L AD ,t L U/d
CONTACT 6uA�� �� 6J +4Sa / (y2475;2762Cti-S1-® 4ca
•
LENDER NAME Per RCW 19.27.095:
•
• • Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -.
R DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
•XISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ t1'' f,S cn
SPRINKLERED BUILDING? YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ,$NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER o LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
- - . • • . • y
AREA DE.PTIONEXIST . :,._. _ .
PROPOSED TOTAL
BASEMENT SQ• SQ.FT. SQ.FT.
FIRST
SECOND
•
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR ❑UNCOVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS ( E7a$TINO l PROPOSED 1 TOTAL TOTAL EXISTING sr TOTAL PROPOSED Si
TOTAL Sr
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
M FIXTURES
Indicate number of each type of future to be installed or relocated as part of this project. Do not include existing fuctures to remain.
MECHANICAL
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS)commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS)or Tub/shower combo) LAVS(Bathroom Burka) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS
ELECTRIC WATER HEATERS SINKS ( ey
WASHING MACHINES1111
HOSE BIBBS SUMPS
SIGNATURE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best of my
knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with all applicable
City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the issuance of this permit
does not remove the owner's responsibility for compliance with local,state,or federal laws regulating construction or environmental laws.
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, 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.
SIGNATURE: t_____;.;/ i.�4 �'' DATE 7-.cr.-2 G/ `-
• operty Owner and/or Authorized Agent
rotl m-(040-co1
o NEW a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? o YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO
•
Bulletin#100- August 16,2007
Page 2 of 4 . fclllandouts\Permit Application