07-106415 •
flee — 4C 1 C.
CRY OF
Federal Way 9 7°17 PERMIT
COMMUNITY DEVELOPMENT SERVICES'' SF MF CO ME EL PL DE EN FP
ONI
33325 8TM RVENUE SOUf'f-f•PO BOX 9718 �,‘�rPLICATION T.
FEDERAL WAY,WA 98063-9718
253-835-2607•FAX 253-835-2609`�� �G>y�7
u;a,o.r;ti,o -ticanuua1coin 1 n1`,l.A.J"
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
Q
SITE ADDRESS ‘'.1.)I)`I�� 0alf‘
�;' �ua 1 SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# O 1 i / iq LOT SIZE(V)U ����((��C T
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) `-e d/ Gil Way
Condos 81A (( �,f/� 4fr/,"
/Attach separate page f lengthy leg escripmN
PROJECT INFORMATION yyJJ
TYPE OF PERMIT ❑BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL Cl ENGINEERING X FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailad description of wok included on this permit onlu)
5rn kh c S th(r c 2 i i court e. f(�WQ+ ppipe. -firs co tec-fior' 5 tir,L ler
S�St JY1 -f rotes - c(\- ri®r 4i 1,, A�14
:S•
PROJECT NAME(Name of Business or Owner Last Name) p-(',_d exa t
• PEOPLE INFORMATION
PROPERTY NAME —, PRIMARY PHONE
OWNER r. (k 1 fycKkyikes
-tJ33j
MAILI ADDRESS T CITY._*TATE,ZIP E-MAIL ADDRESS
�5O X ct C I r_ GP2C —
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
ADDRESS CELL PHONE
Fi-ce_S�. stems `�4.�eLl 6 k jssCY-1 ,[1 ( ) Q. -a(o'7'7
5)-1+-11 Ave / R.corrg /W� 'i2/L"/ (
COY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
/ -"7-_00eos 00 /2/3,D/c,7 ( 3 ) 9,2e2-23.5-0CONTRACTOR'S REGISTRA ON NUMBER EXPIRATION E-MAIL ADDRESS
COPY of card required
with each applieatltn (=>
fS/ OT ///,..2/6 g Jisehber P eSath-pre cOr1
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
mi-k>1 Fire S';U`S-4 mS ` �I�,c1�� C�IaSSman cas3 )ails -a��n
MAILING ADDRESS "I� CITY,STATE,ZII' CELL PHONE
11CAP Sym Ave__ E -72i..cCincc,&)/9 'ig1/2 c ) -
RELATIONSHIP TO PROJECT �LT . FAX NUMBER
❑ Architect ❑ Tenant ❑Agent Other p+'� e K,
PROJECT NAME / /� f� PRIMARY PHONE"� o /1 E-MAIL ADDRESSp.,,
CONTACT JiAch✓ ! /S 1 e/ ( 5 ) ci-2✓ - �d 34) j1�se'IJ ix??0,c7)46-re`CPI
LENDER NAME J Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY.STATE,ZIP PHONE
a DETAILED BUILDING INFORMATION
EXISTING USE L.-�1 " I( - PROPOSED USE C (i l .‘1C 7
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? kYES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? YES ❑ NO
WATER SERVICE PROVIDER X,LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) ``
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
�' k j ■ PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
BASEMENT SQ. FT. SQ.FT. sg.FT.
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
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 offixture 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
BBgS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(Commercial)
COMPRESSORS FURNACES RANGES
DUOIS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS or Tub/Shower Combo) LAYS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS crones
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.
NAME/TITLE 7 f GiaJjinta/4.-1 DATE ///2487/4 7
(Signa[ re) ('title)
RELATIONSHIP TO PROJECT ❑ Owner 0 Agent o Contractor 0 Architect Other 6'1)/9/CV/A'
FOR OFFICE USE ONLY
o NEW ❑ADDITION o ALTERATION ❑REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑NO BASIC PLAN? ❑YES ❑NO
ZONING DESIGNATION CHANGE OF USE? o YES ❑NO
NEW ADDRESS REQUIRED? ❑YES ❑NO UP/SEPA/SU? ❑YES a NO
PLATTED LOT? a YES ❑NO DEMO PERMIT REQUIRED? ❑YES a NO
Bulletin#100—January 1,2007 Page 2 of 4 k\l-Iandouts\Permit Application