09-103166 �,� RECEIV' - - IDS ( Cg
ay PERMIT
COYINUMIYDRVSWPMSM SERVICES t 'r ZOQ9 SF MF CO ME EL PL DE EN FP
33325 dTM AVENUE SOUTH•PO BOX 971
FEDERAL 7Y, 98063-9718 o�� DE A"EpT LI CATION T°
253435-2607•FAXX 253-8 35.260,Q
laww.atuoiredemlwau.com (.,,
CDS
The following is required information-an incomplete application will not be accepted. Please print leg{ 1k)or type.
• PROPERTY INFORMATION
SITE ADDRESS £212M Wei_5}y E Way - E # 2
1 ASSESSOR'S TAX/PARCEL# —— —•� — , — — LOTS iiii
C17.1
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) t�., 40 <%0
��F
(Attachs Page far wwew l o/` h ''''S
1 ■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL ' s (//iq 1-
0
❑ DEMOLITION 0 ELECTRICAL 0 ENGINEERING tilt FIRE PREVENTION SYSTEM
PROJECT DES RIPTIO (Provide detailed description of work included n this permit only)
Ilk Si. . ' • V._ . 'Ica -- rL iter N
PROJECT NAME(Name of Business or Owner Last Name) 1 x ei Jcx.Ind bk"a_14JI /r+he r S
U PEOPLE INFORMATION
i'
PROPERTY ME ]� /� PRIMARY PHONE
OWNER 1(�1�okcc u ,/�.elnpW 71-- L..C) (?�6)2 - QS-SS
1P89.0 R7 r4- +ESS WUi t so T0)uu.xIa l �`''i\ !$n CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
CYCWAS
_*VVYC2`C'MV- -dor) (.)e�\(c.k �ThsOh VS) 4181 -7t f
CELL PHONE CITY OF FEDERAL A BUSINESS LICENSE NUMBER \l ACi€-e 2.11
ION DATE FAX NUMBER
� Iga�sIo � `�r'6� -- (/2S)%' / - ç
!
I/I CONTRACTOR'S REO TII AO MBER •EXPIRATION ,ATE E-MAIL ADDRESS
GSDWNVPo4L.It L, 6/' eSA.e.rOt,r nt..00b7
APPLICANT CQMPANY NAME APPLICANT NAME OFFICE PHONE
Y'ov,3ti1 c1�.e_ -Pc+u� �1CO K6o)v) (42G) 1/81 -7100
roma�gDDREss)�� C S1TlATE,ZIP` t q CELL PHONE
yinlRELATIONSHIP TO PROJECT `` C" l 1 FAX
FAX NUMBER
0 Architect ❑Tenant 0 Agent g Other Conir0ar (43) 481 -MS
PROJECTN E PRIMARY PHONE E-MAIL ADDRESS
CONTACT 3e5 \Cr. w \ (ills') 487 -7(W F/ j t! la e Crown .c-,
LENDER NAME Per RCW 19.27095:
Lender information is required if project value exceeds$5,000
MAILINO ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE C.OneWnf-rC,10..\ PROPOSED USE Com Ar_la.
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ J i CO•C0
SPRINKLERED BUILDING? ,DYES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO -
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
■ PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOS •• TOTAL
BASEMENT SQ. FT. SQ. " . SQ.FT.
FIRST
SECOND
•
THIRD
ADDITIONAL FLOORS(DESCRIBE)
•
DECK(0 COVERED OR 0 UNCOVERED?)
•
GARAGE 0 CARPORT 0
NUMBER OF FLOORS mann raoeoe= TOTAL TOTAL 1001111t0pmc
ao If TOTAL MOONED ALT TOTAL It
•
*.*NEW HOMES ONLY NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ .
■ FIXTURES
Indicatenumber of each type of fixture to be' • • led or relocated as part of •roject. Do not include existing fixtures to remain.
MECIIAIVICAL
Value of Mechanical Work$ COPY OF BID OR ESTIMATE MUST BE IN. UDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTL i S WOODSTOVES
BBQS FANS GAS WATER HEAT '' MISC(Describe)
•
BOILERS FIREPLACE INSERTS HOODS(commorda4
COMPRESSORS FURNACES RANGES
DUCTS. • GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS ierTub/Shower combo( LAVE(Bathroom Bioko) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(raves
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify under penalty of perjury that I am the property owner or authorised agent of the property owner.I~Wu that to the best of my
knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with all applicable
City of Federal Wag regulations pertaining to the work authorised by the issuance of a permit.I understand that the issuance of this permit
does not remove the owner's responsibility for compliance with local,state,or federal laws regulating construction or environmental laws.
I further agree to hold harmless the Cityo Federal Wayas toclaim(includingco
I any ate, and attorneys'fees
expenses, rney incurred in the
investigation and defense of such claim), which mag be made by any person, including the undersigned, and filed against the city, 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.
� 1
SIGNATURE: /� / L Z12�� DATE ``
Property Owner and/or Ai orized Agent
•
a NEW a ADDITION a ALTERATION o REPAIR a.TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a.YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES o NO UP/SEPA/SU? a YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Pernrit Application