04-101289 R
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E COMMUNIYDEVELOPMEM SERVICES
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9718
FEDERAL WAY,
Kideral Way App 07 2004 PERMIT APPLICATION 253661-4115.FAX 253-661-•1129
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The ollowin• is re•uired in ormation-art incom.Tete . •• 'cation will not be acce•ted. Please •rint le•ibl (in ink)or •e.
'1E1 PROPERTY INFORMATION -
SITE ADDRESS: _ 7- � //,yam/2e . l ," SUITE/APT#
ASSESSOR'S TAX/PARCEL#: _567070O -03 / _ SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTION (e.g.:Acme Estates, Lot 1) Gam'
(Attach separate page for Iengthy legal description)
__. 1 PROJECT INFORMATION ..
TYPE OF PERMIT(This application): ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION
0 ELECTRICAL 0 ENGINEERINGXFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only):
/057-2z-t_ 6 " f Simi vl�t ,. SET T4--- .1 '1'Gc' FZoxI •
-'-c�1e-t . 76 • ' a' i L /. G — — 'a Gce-tA
6"/JGi%4 J4s5-el. r_)1J ftp j- „_____ _4 I T' ,
PROJECT NAME(Name of Business/Owner Last Name): Rot 1 A U, 5 H e
• . E:'PEOPLE INFORMATION
PROPERTY NAME: PRIMARY PHONE:
OWNER 00 i'l`l-/Ev72E I J.-C. �lN fl 3 tz t (� 7 Z) O 74
MAILING ADDRESS(STREET ADDRESS;): / CITY,STATE,ZIP
Z 3 33 >vLI-Zit' /--�t.IvT" ,i Ar-4-"A"D Grp X 86 3 3
CONTRACTOR NAME/.^ 4 1 z 19/`/^y, } COMPANY OFFICE PHONE:
'AILI1/GSDA4_SS'( E7ADDRESS;I?scAp1,14, g.---,,'ATE.ZIP (7-- 5134 -61393 egrl2
i CITY, CELL PHONE:
I° 2-1-11' 'i4t`4nzzEr S. -aceinA 4(274. d oif` (253)A -X745
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: EXPIRATION ATE: FAX NUMBER:
- - - / / (x63)s3t4- q 9z
CONTRACTORS REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required with each application) / /
LENDER NAME:
(If Proposed Value>$5,0001 50‘,0)4.
,0"I/ .C�fry ) DAYTIME PHONE: —
MAILING ADDRESS(STREE ))T ADDRESS;): CITY,STATE,ZIP ,,zz,�,�
APPLICANT: NAME: COMPANY
OFFICE PHONE:
74,4-94.A-1 P7:,2Z -2v f--. 6- 0:77_44::77 /,,Jc (0.„ _.3) 0 33- Aztic
MAILING ADDRESS(STREET ADDRESS): CITY,STATE,ZIP _/ EVENING PHONE:
/?a L ST?' _f -e ,z.v S( .72. i/ ( ) / - /3/.S
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ Architect ❑ Tenant -Other(Describe)-.66-XAr.Rj - �pe."1/ 9c (Z. ;J.) 9337_Gtr �,C
CONTACT PERSON FOR THIS PROJECT: 0 Property Owner Contractor 0 Applicant -E-M IL ADDRESS:
ct (Carte �Ce- ,..
•
■ DETAILED BUILDING INFORMATION '
EXISTING USE: PROPOSED USE: I-2 ��
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: o YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
•
AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
-SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL.EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
**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.SYSTEMS
BBQS FANS HOODS(Commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS troarr 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.
NAME/TITLE - - _ DATE ,�7/�
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner ❑ Agent ❑ Contractor ❑ Architect a Other
FOR OFFICE USE ONLY
o NEW a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a YES o NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—March 30,2004 Page 2 of 4 k\Handouts—Revised\Pcrmit Application