04-104228 •
REC •t
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FederalWay OCT 15 2QODERMIT
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE EN( FPj
33530 FIRST WAY SOUTH•PO BOX 97180 TV C A'r--PLICATION, \.�
FEDERAL WAY,WA 98063-9718 CITY T Q F r� T� / /
253-661-4115•FAX 253-661-4129 BUILD)t'
www.cituoffederalwau.com
The ollowin. is re•uired in ormation-an inco •lete a••lication will not be acce•ted. Please •rint le•ibl in ink or t .
Z PROPERTY INFORMATION
SITE ADDRESS /4 3 0 SDuiN 3 3 0-til SUITE/UNIT#
ASSESSOR'S TAXI PARCEL# - LOT SIZE (sj)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal clescnption)
PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERINGX FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
K i rc HOU /f,o Fitz( PRcccrtevJ
dr 1 PROJECT NAME(Name of Business or Owner Last Name) mizni!1 �� L..__� �� //., iP
PEOPLE INFORMATION
PROPERTYNAME 5c �'j' (N U PRIMARY PHONE
r/I
OWNER kC14
. ( )
MAILING ADDRESS CITY,STATE,ZIP
(4770 'St,t-i4 3O ( ( moi Y, iii/ 99033
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
5/mac(6R/AA1(LL pp/0 Cog-ts (i66 ) 29i -leinn
MAILING ADDRESSIT'F CITY,STATE,ZIP CELL PHONE
95Su
20 tdi-l1 4u6- 5 mo tb4 5281049 ( -)
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
2d-Do- I dL86o - B L 12 iii ' l ( )
6 CONT_ Ij.P
RACTOR'S CRATION NUMZER(copy d J,equired with each application) ( 2EXPI IO1N DATE
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
SiM) .O(6,410k) L QU'h (re) (zoo) z91 - /4ot'
MAILING ADDRESS / 5�h j.F CITY,STATE,ZIP CELL PHONE
95�o Icy A `> xe, ,-/-crj £-) 7 %:ae ( -4------
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent Other(Describe) (•e''tKQC71]^ (2a6) 29/ - /5cO
CONTACT NAMEPRIMARY PHONE E-MAIL ADDRESS
%�A-r�i SSC j CZOS ) 29/- /462 k4666E s @ IidaW firt-A-t.,.
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? [ YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES n NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA n PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
• S
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL Exurtura TOTAL PROPOSED TOTAL EXIST/NG arm PROPOSED
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $ 29 5 /
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
X
BBQS FANS HOODS( pcial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS(Toilet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks) 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. 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 s� DATE /O1�. �O1
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent Contractor 0 Architect 0 Other
FOR OFFICE USE ONLY
o NEW n ADDITION n ALTERATION n REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES n NO BASIC PLAN? n YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? C YES o NO
PLATTED LOT? o YES 'n NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100—March 30,2004 Page 2 of 4 k\Handouts—Revised\Permit Application