06-104841 REcEIV •
CITY OF "�. SEP 2 2 2006 C - L /
rIW � �
Fede a Nay PERMIT
COMMUNITY DEVELOPME FflpERAL WAY SF MF CO ME EL PL DE EN' FP
333258TH AVENUESOUIH•POBO bLDING DEPT•
FEDERAL WAY.WA 98063-9718 APPLICATION -In
/ /
253-835-2607•FAX 253-835-2609
www.cituottede ralwau.corn
The ollowin• is r •uired i ormation-an incom•fete a••lication will not be acce•ted. Please •rint le•ibl (in ink)or j• .
f�
• PROPERTY INFORMATION
SITE ADDRESS I D 4c-)J s. 308111(�111 SUITE/UNIT#
Q
ASSESSOR'S TAX/PARCEL# 0 V 2_ I 0 14 - CI 0 q 2-' f1
LOT SIZE(s
LEGAL DESCRIPTION- (e.g.Acme Estates,Lot 1) o QO a( o t4 4. e_ 3 3.9 .Th , t C t Kl I/Z- 0-6
SL,L) I'-1 ♦yf Q`.� 1/t4 LO Q (Attach srix p e for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING 0 MECHANICAL /
ID DEMOLITION ❑ ELECTRICAL 0 ENGINEERING GI FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit ondu) FIDE S�2(6'i��P<'.�STr;r j
F\d d anti, Freee. S(' t-e tb v J h fi KT s pr( r�k-I slls�--..e.,-i- 1-,der
lick t_ port c orc►rkL . Add+ y-‘ l_,0 Ire '
RC- ()c ato -Q-N[Sh v. a.6 f-.D.0 . wt le-VA CA-V\ L i Xish dem
To k li e -(o-ems ref e ei Lc-k_. . ( FDC = el-rf DQ pi-, co A vv tctiOr..)
PROJECT NAME(Name of Business or Owner Last Name) 1.- I fe. Care C e atilt- ,
• PEOPLE INFORMATION
PROPERTY NAME v>n�Q I c e•^F /I PRIMARY PHONE
OWNER Fede rG- L�I l J C `l Lifr. aibems ( ) -
MAILING ADDRESS CITY,STATE.ZIP
et° S i-raiee iS ?o Bc* "12-3 5 Lt? Arta-i•..iu h A 3 o- 3
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
SimplAycGrt.a YALE I v a-Fhi o•Recur ( 20U 241 - 14-ce
MAILING ADDRESS C STATE.ZIP CELL PHONE
g Sao to-14A Ave S.til ob Sea i-R t e. winqg(o$ ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
1 o — qq-1 G. 74 5 -BL / / ( ora) o,.t1 - 19oo
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
6 1 M PL L $ 813 Co 0I / 12 /07
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE 14 o
5impleKc-.1vinyl e►I (Wig; o'Rear ( 2010) 2Rt - Ilio&
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
g5ao 10414 Ave- S. 4 t C)a Federal wci..4./ WA ( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect 0 Tenant Agent lif Other(Describe)511.-3° C4'"bre.e-kOY ( a01o)9-411 - 1 S 00
CONTACTN E PRIMARY PHONE E-MAIL ADDRESS
1Ta(-Irl' it Gear ( 96/4.)2.41 - ('l-ti 11-4rearC3 t yeo i ni--.00
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
IN(k ( ) -
■ DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN o HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
410 •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
sg.FT. Sg.FT. Sg.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT CIDJI Pp Itt oe e_
EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**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 p ur) ov
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES ' MISC(Describe) n
COMPRESSORS FURNACES GAS WATER HEATERS Fi� ,,()12-tt.w:.-t `
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS lbuet) 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.
C �
NAME/TITLES Q. OWN. /� Jl t �`'"y�//`/��^+ DATE
// (Signature) / (Title)
RELATIONSHIP TO PROJECT ❑ Owner gent p,Contractor 0 Architect Other Con
S
FOR OFFICE USE ONLY
o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? ❑YES ❑NO
ZONING DESIGNATION CHANGE OF USE? ❑YES o NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? ❑YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES ❑NO
Bulletin#100—January I,2006 Page 2 of 4 k\Handouts\Permit Application