07-106411 o ece r
an OF 6 1 - 16 loci i'
Federal Way Dov ti 9 2°°°P. RMIT
COMMUNITY DEVELOPMENT SERVICES • WR. SF MF CO ME EL PL DE EN FP
3332E D AVENUE WA 5•63 971 97,G of f' ', ' • ' 'LI CATI O N �°
FEDERAL WAY.WA 98063-9718 s/ ` /
253-835-2607•FAX 253-835-2609 `"�`n t,`� '�r
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS cS 1)\I 00 -aU v U f 1
'P� SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 0 ok- I 0 A- 1 g_ LOT SIZE(sfi
69 2/4/0?HZ r" _R_ fg_ /�
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) r df ra\ Way Condos 8i 1 Id 1( t 4'
(Attach separate page for lengthy leg description)
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING O MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL 0 ENGINEERING XFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of wok included on this permit oni)
Smih hire SLsi-unS will lcoo e II )WQ pipe, re r�
pro spry,Lte
suis-un to KQteC4- '--h€ tit kf(ar 0-V-- e cuctlil.
t
PROJECT NAME(Name of Business or Owner Last Name) d e('a i W ck _ °n V\c n1 C 13
kb(,9
• PEOPLE INFORMATION
PROPERTY NAME _ PRIMARY PHONE
OWNER OLtA+\ vl2k Ftc'_Me:..$ t l C ( .i) '1)) - 0.3))
MAILING AnnPFSq crit.STATE,ZIP E-MAIL ADDRESS
P9 BOx "l30 meet-r-t86(1C✓
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
5mci-hEireSti&i-ems Sh,.^Ie'(--,V/S�S�m�'}an},/� (d53) ayg -0(v'7'7
LING ADDRESS CITY,I 11 p -J�+h Ave g _�Q.CPI�a &I % /2f/ (IP ELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
i''
/ —87.-a0oo53--t20 &_ /2/3ijo'7 c ) 9a&-23s®
COPY oteudrequlred CONTRACTORS REGISTRAI OONN NUMBER EXPIRATION TE E-MAIL ADDRESS
with each appllutioa yl�� � ` /367
0T
��!!1 •1J\ /�/IIYA ///�./6 g 15 Eh bel'�e�1 Sa�I�h`�r`re.carp
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE u
LING
TiCQ RgSA,e mS s�1_us G toss(man (as3 )a42 -3(e-19
ADDRESS CITY, CELL PHONE
C)(9-Sy A-h Ave_ E Tacorn ac (u F7 (18014 ( ) -
RELATIONSHIP TO PROJECT COO ? .0 FAX NUMBER
❑ Architect 0 Tenant 0 Agent VOther r./n`1/aye (a53 )qC2 -3 30
PROJECT NAME ��( /� /(/7 PRIMARY PHONE/ p E-MAIL ADDRESS
CONTACT \JIASl / /Se_i- e i ( j) 9 - I g80 ()sen r( tcm�re`C
LENDER NAME Per RCW 19.27.095: �J
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
a DETAILED BUILDING INFORMATION
EXISTING USE C_C3rd O S PROPOSED USE C Q r- d c.
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ /, / j-
SPRINKLERED BUILDING? AYES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? '(YES 0 NO
WATER SERVICE PROVIDER kLAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) //
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 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 PROPOS® TOTAL TOTAL E csrrnva SF TOTAL PROPOSED SF TOTAL SF
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
• FIXTURES
Indicate number of each type offbrture to be installed or relocated as part of this project. Do not include existing fixtures 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 INSERIS HOODS(Commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SE,lb REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSE IS rroueu
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
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 _ .�.�iV.� DATE u//287/6
(Signa re) (Title)
RELATIONSHIP TO PROJECT ❑ Owner 0 Agent ❑ Contractor 0 Architect Other einp/O- ge
FOR OPne i - '
o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? ❑YES a NO UP/SEPA/SU? a YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES a NO
Bulletin#100—January 1,2007 Page 2 of 4 k\Handouts\Permit Application