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Federal Way --�
PERMIT SF MF CO ME EL PL IiEENG
• C:51 fr1YD&VELOPMENfSER Y OF FEDER
33375d^aAVE1VCfiSOUTff•roaox4 BUILDING D 'pLICATIO N
FEDERAL WAY,WA 98063.9718 0 /
253-835-7607•FAX 753-835-7609
www,dIuofederdwau.tom
The oilowi • is , Fred in ormation-an Inco •fete a••lication will not be acce•ted. Please •tint le•ibl in in or
• PROPERTY INFORMATION
SITE ADDRESS 36)53'6 I ir\v e-- , S . SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 0 3 2- ( 0 (-4 _ e 3 J LOT SIZE(sj7
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal descriptio,)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 62"FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
Odd-01 I. 17) 0(.4 CO P. 1 e A 1.GJz.,'vy, r p yV, `t of-t .tY ik-0L3 5'P' : ,. A
4,vt),1" a-i)3 all t't U 6 t51,1/Q. f ilAJ2, F/A CALt,'t C.A ,
PROJECT NAME(Name of Business or Owner Last Name) )OL j Y l riAeh{— 4 ia..se.� A i-z_ Q. J
MI PEOPLE INFORMATION0
PROPERTY NAME
PRIMARY PHONE
OWNER Ir'G Co, (-�j4 [ ulA ( ) -
MAILING ADDR CITY,STATE,ZIP
(PCO bVfr -ea1i.,i4L, LU, i {, -.1,U'i i/k ii4- 2N%
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Prfyn.►&,r Sy -1 x, 47 (LI2_5)s14 -94_ s
MAILING ADDRESS _ CITY,STATE,ZIP CELL PHONE
/,vim 'A ( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE FAX NUMBER
-110-, '1- ► d t1 ( G LL-B. L (1 3 ( / 01: ( ) -
CONTRACTOR'S REGISTRATION NUMBER(copy of card/required with each application) EXPIRATION DATE
e et6_ frt .L 4-7X- '1- L ,pr j c / c , / G'i<
APPLICANT COMPANY NAME y �/� p APPLICANT/ NAMErp/� OFFICE PHONE
MAILING ADDRESS (i a 9 _1.l V-14 t V�( V,R all — (2-6(0) 7 611 -14-hog
_ CITY,STATE,ZIP �p g MDU n
0 1 tf1/1 A ve'1 c_, - 11100 Hi VLii"\ ( .�-!. ) ) ILIcv
RELATIONSHIP TO PROJECT // FAX NUMBER
0 Architect 0 Tenant 13 Agent ta"Other(Describe) `i0.-19 t- \"tVttt.A?Y (�LP) Z6
1( — (900
CONTACT NAME PRIMARY PHONE
E-MAIL ADDRESS
1-tt1-h; ()Rea_ r' (24( ) c`") -Its SS �/�
�'� SG
Z r1t ���IC�irj�.l'C'v�
LENDER lv/
MAILING ADDRESS CITY,STATE,ZIP
•
•
• ■ DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE 41-'4 C4-y. -2
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ V 5/V,
SPRINKLERED BUILDING? a YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES 0 NO
WATER SERVICE PROVIDER a LAKEHAVEN a HIGHLINE a TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAKEHAVEN ❑ HIGHLINE a PRIVATE(SEPTIC)
t> .;) o-7
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 0 CARPORT 0
..,Xe 'dr a AL'
NUMBER OF FLOORS vas-rum PROPOSED rotor 1q r
**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 $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.S STEMS
BBQS FANS HOODS(commercta�► WOODSTO ES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(erTub/Shower Combo! SHOWERS WATER CLOSETS(roses) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Nola! 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 authorised 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 '42,141i ( N. S �Vl r -A ��---e DATE '6 '
(Signature) VAgent
RELATIONSHIP TO PROJECT ❑ Owner ❑ Contractor 0 Architect L/Other L ) C ) Y
9e,(t,q)s;(e ) e';t &VII.
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Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application