06-103588 RECE ! - ( C� 3 S
CITY OF iv,, , i / /
Federal Way �/ PERMIT "C
COMMUM7YDEVELOPMENTSERVICES SF MF CO ME EL PL DE E FP
33325 STM AVENUE SOUTH•63 BOX 9718 JL O ZlAPPLICATION TD
FEDERAL WAY,WA 98063-9718
253-835-2607•FAX 253-835-2609
www.ciiyofederalu,ati.tnm OF FEDERAL WAY ."'�-.: _'
UILDING DEPT
The following is required informatidzt-an incomplete application will not be accepted. Please print legibly in ink)or type.
■ PROPERTY INFORMATION
SITE ADDRESS 8 }(J r LA3 r"(Ga 7 SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 1 7 /
( c / 9( LOT SIZE(sfl
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
L '' •' :,:, 1 ;PROJECT INFORMATION.; ,; •,. -- • ._ .
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
❑ DEMOLITION 0 ELECTRICAL 0 ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
1-417 1-4)....1 CL. 1 0--Y1 , -1 0_,i'L IL () Ci 1_k_i.Lr-ra I~) re.
f:-')u.pp(e S Sie-Y1 -1t-ei-,-, .
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PROJECT NAME(Name of Business or Owner Last Name) Fe d e (..)06,.., ' C o
(Ci' (..)06,.., Ce-,-E '•
_V . ";,;NI PEOPLE INFORbIATION •
PROPERTY NAME (1 - r PRIMARY PHONE
OWNER Y L. I 1-A—/ (
MAILING ADDRESS CITY,STATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
k=r I-tCE e. (.1i°tck, 1 v i- 621-v. +'l:r ri teaICk1(?.r1e, ( -)J 17;L„ 0 f)-tu1
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
(1_,0 I CC (, ,m 6L - tic "ib•iGc�.., ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
rIO
CONTRACTOR'S• REGISTRATION NUMBER+ �
(copy off card
(required with each application) EXPIRATION DATE
APPLICANT COMPANY NA)* APPLICANT NAME OFFICE PHONE
( ) -
MAILING AD ESS CITY,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT . FAX NUMBER
❑ Architect 0 Tenant ❑Agent 0 Other(Describe) ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
k"//57`0M /cMei/ IF (__?lXa) 7 -0'
NAME
LENDER �- ,r, 76
vrN•
MAILING ADDRESS CITY,STATE,ZIP PHONLF'—
( ) -
r -' :-,.r',..',',:';,'':;.'.';';' ::';': ':'..`•:,:',. ' ‘:":,'');','',;,;').::'!!,,111 'DETAILED BUILDING INFORMATION ' ,r.,:;' } `�.: ; I ' + ..r ` ` '
EXISTING USE PROPOSED USE
c._
EXISTING ASSESSED/APPRAISED V: UE $ VALUE OF PROPOSED WORK $ (,1 .� 7.3T. 'r.r t a
SPRINKLERED BUILDING? ,.r. YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? LYES 0 NO
41111NWATER SERVICE PROVIDE• 0 HAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDE• a - 1 HAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
• I
'•'PROJECT FLOOR AREAS •
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ. FT. SQ.FT.
BASEMENT
FIRST �.
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?) /
GARAGE ❑ CARPORT❑
EXISTING PROPOSEDso TOTAL
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
= FIXTURES ':
Indicate number of each type of future to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Wer
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(com.n.reiEks WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES -e_ MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/showorCombo) '•WERS WATER CLOSETS(rode) MISC(Describe)
DISHWASHERS SIN' DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMP' f RAINWATER SYST
WASHING MACHINES URIC .�: HOSE BIBBS
LAVS(Bathroom Sinks)
'ACUUM 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. �,� }/J
NAME/TITLE / �li�C .��4'//G1I O •? • DATE },
(Signatu (Title)
RELATIONSHIP TO PROJECT LI Owner 0 Agent Contractor 0 Architect 0 Other
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Bulletin#100—January 1,2006 Page 2 of 4 k\Handouts\Pemut Application