06-100931PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
NAVE PRIMARY PIjObTE
l+J 0" + 't'l,-eC- I (Sb;i) M - ZG�eo
MAILING ADDRESS CITY, STATE, ZIP
?A 9"0 trJ crt : I FbCl-tL_A-�)OR-
COMPANY
2
N,YNAAME a
CfOMMPPA,,.
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RECEIVED*
OFFICE PHONE
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FEB 2 8 2006 00,100
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Way
PER
ITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
COMMUN17Y DEVELOPMENT SERVICES
F MF
OF FEDERAL. WAj�
CO ME EL PL DEE FP
33325 8TM AVENUE SOUTH • PO BOX 9718
L WAY, WA 9800-9718
AP P LI CATS` DEPT.
53-352607• FAX 253-935-2609
wwu. cttyo,(/ederatwnu.�um
The ollowin is required information - an incom fete agielication will not be accented, Please laTint le ibl (in ink) or
PROPERTY INFORMATION
SITE ADDRESS
�,, (N�) (�.
SUITE/UNIT #
ASSESSOR'S TAX/PARCEL #D
(� C�-• Z�- O (� Q
LOT SIZE (s,)
LEGAL DESCRIPTION (e.g. Acme
Estates, Lot 1)
(attach separate pa9elar Lmdw L -gal de—W oN
PROJECT• •
TYPE OF PERMrf
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERINGZFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of w " �id on incl n this Dermit onlu) //
11y^�stvl at
u o� 4t�.�•G - ��2
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PROJECT NAME (Name of Business or Owner Last Name) (W r
r6 —
PEOPLE•• •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
NAVE PRIMARY PIjObTE
l+J 0" + 't'l,-eC- I (Sb;i) M - ZG�eo
MAILING ADDRESS CITY, STATE, ZIP
?A 9"0 trJ crt : I FbCl-tL_A-�)OR-
COMPANY
2
N,YNAAME a
CfOMMPPA,,.
W�,'�`co*,�'f [2�liC.'{1,e�rJ
PLICANT NAME
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OFFICE PHONE
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MAILING ADDRESS
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CITY, STATE, ZIP
CELL PHONE
CITY, STATE, ZIP
ITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
FAX NUMBER
%%0CO
�" r
t
CTOR'S REGIS ON NUMBER (copy of card requited with each application)
$aW_ CSC q 3g _
EXPIRAATI•ON DATE
5/ iel /0
CO P�ANY NAME_
APPLICANT NAME
OFFICE PHONE
(��•Y-reT'3\
PHONE
( ) -
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECTFAX
NUMBER
11 Architect ❑Tenant ❑Agent/2fOther (DeScribe) ��L
f C7.
NAME 4/l l_'t4" PRIMARY PHE - - E-MAIL ADDRESS
Per ROW 1$:27+095: ,Letuf ' Wo"Antion u
requited jfpnbh ct value ezeeeds $5,000
NAME �/l � "
tam+\(/
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
PROPOSED USE I<irArt L'
EXISTING ASSESSED/APPRAISED VALUE $ �y VALUE OF PROPOSED WORK $ 1
SPRINKLERED BUILDING? VIES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ,a"LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER 9A AKEHAVEN 0 HIGHLINE ❑ PRIVATE (SEPTICI
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
. FT.
PROPOSED
SQ. FT.
TOTAL
SQ. FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED?)
_
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
gam'
1tOP D
Z�gy
Z
' °o °a' -
r°r"`'rt°'bn®w
=AXW
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
number of each type of fixture to
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS WTub/shower Combo)
DISHWASHERS
GAS PIPE OUTLETS Y
WASHING MACHINW
LAVS (Bothmom^sln-kel
le installed or relocated as part of this project. Do not incl
APORATIVE COOLERS GAS LOGS
FANS �OD erFIREPLACE INSERTS $FURNACES ER HEATERS
GAS PIPE OUTLETS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
existing fixtures to remain.
WATER CLOSETS Irone4
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
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, includi its officers and employees, upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE DATE o� d !) /0
(Si ature) (7YUe)
RELATIONSHIP 7RROJECT ❑ Owner ❑ Agent XContractor ❑ Architect ❑ Other
Bulletin #100 -January 1, 2006 Page 2 of 4 k\Handouts\Permit Application