07-106413 REcowii f
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Federal way `�' PERMIT ( (`T!/
COMMUNITY DEVELOPMENT SERVICES �pEF�AL YM SF MF CO ME EL PL DE E'i FP
333258TM AVENUE SOUIN•P0 BOX 9T 16JF{�r,1G'APPLICATION CATI O N
FEDERAL WAY.WA 98063-9718 BUILDIN TD / /
253-835-2607•FAX 253-835-2609
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The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
I. PROPERTY INFORMATION
SITE ADDRESS 6 1 I 0 -a 8 till Ulf f 5 SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 0 (�1 - LOT SIZE(s
fi
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) '— i 0 0 a d OS r ( A ( i
(Attach separate page for lengthy leg. descriptlerg
a PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL `,
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING q� FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of wok included on this permit oniu) "
5m6i Fire SLjsftO S c.i!1 !cavi e (I)wry- D -are rofec+;on sp,nn ter
s sin -1-c0 (oteck +-h�. in-q nor o-P -4he bur�dtvt
,s.
PROJECT NAME(Name of Business or Owner Last Name) r't <�InU ti-tQ.5
t7 5-
• PEOPLE INFORMATION
PROPERTY NAME �" PRIMARY PHONE
OWNER <�Gtz , �v 1� �IGwt�.S t ( C 1, -CI �1
MAILING Anr1RF.ec `.�••v n tt cm, CreTF 7IP E-MAIL ADDRESS ..
_ P0 BOX 930 , - J -Sumne-c �I$:3`1
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
3mvih Rt reSq&&-ems Sh1/4.1e j( lass mcon 7 (asi) ayg -o o 7'7
(TILING
AD RESS 5.) T►"] rlve� ONE
-a.comm W9 %21J 2J (IP ELLPH)E
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER l- EXPIRATION DATE FAX Num)
IBER
/6-27.–D'o005c 00 - /2/3/le7 ) 9&-,23s--o
COPY of card required
CONTRACTOR'S REGISTRA OONN NUMBER -/p'� EXPIRATION TE E-MAIL ADDRESS
with each application ,...i.-4),/.7/4)
/" .O/ /) I` !,?/'O I
7 7l/!xA /// jisenber�{eresfn-th-l`re." �
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE U
l}'�,I�p1-'(IMM(ADDRESS cny.'i h LV1 Ce S�IS�4 mS ins/rile_ G friss(Ulf fU c as3 )aI 2 -a�'-n
1 1 0 W-5 l A V� ��^(A.i-V/t t K' / W/ / �V! G I I CELL PHONF. -
RELATIONSHIP TO PROJECT coot-7-a, FAX NUMBER
0 Architect 0 Tenant 0 Agent ?Other em,i0lq e yL cas3 )V10 -,3 35-0
PROJECT NAME ��( /� (/� J L�n� �^ PRIMARYIMPHONE/lp E-MAIL ADDRESS �`��
CONTACT �U��i / /Vt C�l� c t�/ Lav,: ) 9a - i 'co jisenl/l.f ti[o la/no
LENDER NAME `J Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS COY,STATE,ZIP /PHONE
( ) -
a DETAILED BUILDING INFORMATION
EXISTING USE (_0[ `[°5 PROPOSED USE COr ^`" o.Sen„)
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ �,
j 30
SPRINKLERED BUILDING? 7\YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? p'ES ❑ NO
WATER SERVICE PROVIDER (J.AKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER /❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
sg. FT. sg.FT. sg.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL=STING SF TOTAL PROPOSED SF TOTAL SF
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
II FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existingfixtures to remain.
MECHANICAL
Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATNE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBgS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(commeretai)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SEAS REFRIG.SYSTEMS
PLUMBING
BATHTUBS for TIM/Shower combo) LAVS(eamroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSE lb prones
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certlfy 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. 1 Q� /�I t
NAME/TITLE < J(�i�.X�-y C--)/ •4,� DATE 11/28 t/ f
(Signa re) rifle) "p 111
RELATIONSHIP TO PROJECT 0 Owner 0 Agent o Contractor ❑ Architect Other Lri 2/0//
YfOIk iFP'I<pp� ONLY ... ..
a NEW o ADDITION ❑ALTERATION ❑REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? ❑YES ❑NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES ❑NO UP/SEPA/SU? ❑YES o NO
PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? ❑YES a NO
Bulletin#100—January 1,2007 Page 2 of 4 k\Handouts\Permit Application