08-104832F� RECEIV D'
PERMIT
onmA8VnVnX9C T 13 2003
PEDBRAL WAY WA 98063-9718
���°''F�� • F FEDER LP T -
I CATI O N
I LS 1-3 -z-
SF MF CO ME EL PL DE EN(116)
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The following is rr quined ation - an bwompbite application will not be accepted. Please print legibly (in ink or ftqm
PROPERTY• •
SITE ADDRESS _ 283 010 Tac � !; c- titan S. Fcd ela 1 gni a o WIN SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # 1 _Q�, LOT 8= (sj) 7-0 L-4
LEGALDESCRIPTION . r _ . �.c
PROJECT INFORIIIATION
TYPE OF PERMIT o BUILDING O PLUMBING o MECHANICAL
O DEMOLITION O ELECTRICAL O ENGINEERING o F13M PREVENTION SYSTEM
DESCRIPTIONPROJECT
I 'ur �r:a .0 • a .w r ee
I
i
,�-
APPLICANT
r•;
w— m7rowArmis
=Nil
N PEOPLE INFORMATION
NAME
PIm1ARY PHONE
11 Ferro c
25) L113 - iIb1i
MAU.INO ADDRESS CUY, STATE, ZIP
N-MAMADDRESS
z4,oz , maple vat Hwy.. Z�.9 Nla ode Va11 vu C156
CDJM meeNo
TGD QO G. at --z 5
a ii..,.
coMPANY i APPIiGNT NAM
T Rkti
OFFMC PHONE
( 503) 533 - y Z
MARAM ADDRESS Z.D Q Z ZOG CIIY, STAM np
CELL PHONE
MAU NO ADDRESS CHR, STATE, ZIP
Soy, 153q - � IQ'L
CnT O DATE
/FAX NUMBER
CDJM meeNo
TGD QO G. at --z 5
E-IWL ADDRESS
COMPANY NAME APPUCAW NAM
OFFICE PHONE
MAUJNO ADDRESS
CITY, STATE, ZIP
MAU NO ADDRESS CHR, STATE, ZIP
CELLPHONE
(0828 mapkc Ue c Hw91412-7► 1 q$03e
253 �i'i2- tl5tilo
RELATIONSHIP TO PROJECT
PAX NUIBER
E3 Architect o Tenant oAgent o Other
(253) 53,0 - Lv
NAME PRWARY PHONE E•MAU, ADDRESS
e
25-3 53 1 - Z ILA le G5:.Aa hr-rcm
NAME
Kv-k
Per RM 19.27.095.
Lender ftlb na[ton to r■pdred VoWoft =due oweede $Ao00
MAUJNO ADDRESS
CITY, STATE, ZIP
IPHONE
E>IISTII�IG USE �' a a S �i t.-�};n pn yr fns pi-�, v PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE VALUE OF PROPOSED WORK *-Lio o o
SPRm LERED BUILDING? o YES O NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRZD? o YES O NO
WATER BEIMC49 PROVIDER o LAKEHAVEN o HIGHLINE o TACOMA o PRIVATE (WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN O HIGHLINE O PRIVATE ISEPTICI
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
80. FT.
BASEMENT
a YES o NO
BASIC PLAN?
o.YES
FIRST
ZONIIFG DESIGNATION
—�
CHANGE OF USE?
SECOND
o NO
i
a YES o NO
THIRD
o YES
a NO
PLATTED LOT?
ADDITIONAL FLOORS (DESCRIBE
DEMO P=Nn REQUIRED?
o YES
o NO
DECK (0 COVERED OR 0 UNCOVERED'
GARAGE 0 CARPORT 0
NUMBER OF FLOORS
s:neno
ror�,
raa�cszaceser
ror�crstarossoAr
tor�sr
"NEW HOAM ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indionte. number of each type of factw a to be ' or pari of this projectDo not include existing firms to semain-
NECHAWCelL
Value of Medwnical Work $ (A COPY OF BID OR ES71MA BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS AS PIPE OUTLETS WOODSTOVES
BBQS FANS WATER HEATERS MISC (Descnbe)
Bpp,g FIREPLACE INSERTS HOO
COMPRESSORS FURNACES RANGES
DUCTS - GAS LOG SETS REFRIG. SYS S
RG
C-M" LAVS pa. mw*URINALSMISC (Deacnbe)
RAINWATER SYST VACUUM BREAKERS
FOUNTAINS SHOWERS WATER CLOSETS pwkq
'RIC WATER HEATERS SINKS WASHING MACHINES .
BIBBS SUMPS
Z owt(& under ponaft ofpojwV that r an the property owner or authorized agent of the property owner. I c rt(b that to the bat of ANY
knowls4 , the b{ %nation sabnitied in support of this permit application is true and oomaat. r csrq ft that r will odiwply with all appumbte
Cum Rf Feda+al WWI regulations pwtxbdng to the work authorized by the issuance qf a paAdt. Z understand that the issuance Rf this permit
does not rsnww the owner's rssponsibiittg for compliance with decal, state, w fetawl laws regulating construction or environmental /acs.
r f further agree to hold harmless the City of Federal Way as to any claim (Including costs, evpenses, and attorneys' fees incurred in the
inwatfgation and dgfenss of such claim, which miry be n ade by any pion, including the undersigned, and flied against the dim but only
where such claim arises out 4tf the reliance of the city, including its offl wrs and employess, upon the accuracy of the information supplied to
the edty as a part offs application.
,, Gln
SIGNATURE:
w
a FEW o ADDITION
a ALTERATION
o REPAIR a,TENANT IMPROVE>I�AT
BUIIAING SHELL ONLY?
a YES o NO
BASIC PLAN?
o.YES
o NO
ZONIIFG DESIGNATION
CHANGE OF USE?
o YES
o NO
NEW ADDRESS RE unm?
a YES o NO
IIPIMWA/SW
o YES
a NO
PLATTED LOT?
o YES o NO
DEMO P=Nn REQUIRED?
o YES
o NO
Bulletin #100 –January 1, 2008 Page 2 of 4 Mflandouts\Pennit Application