10-101379 th King Fire & Res ue
RECE1Op Approved
[,AS Detailed
a F �" 6 2�y=' Subject to attached details _Z12 - 1_ 1113_76
Federal way APR yERM
COMMUNITY DEVELOPMENT SERVICES v1,.. SF MF CO ME EL PL DE E
33325 8n'AVENUE SOUTH•PO
� ry F +
FEDERAL WAY,WA 98063�7Ji V 1 u 1 A I L' 1 I , -Iro /
253-835-2607•FAX 253-835-12609 D v r�
www carol ferletalwa0 cum J
The following is r-'aired information-an incom•lete a••lication will not be accepted. •lease •rint legibly(in ink)or ,•.
i • PROPERTY INFORMATION
SITE ADDRESS -55415 2-1 55 Ave-. 514 SUITE/UNIT tt Q
ASSESSOR'S TAX/PARCEL# Z 5� Z /(1 0 3 - 1 b\ , o 2 - LOT SIZE(sj) t7 1/ )75
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) N 0 Shue V (11 C_ ii l.�
(Attach separate page jar lengthy legal descnphoN ••J
■ PROJECT INFORMATION
TYPE OF PERMIT ❑BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION ❑ ELECTRICAL 0 ENGINEERING x FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work inclndiPd on this permit onlu) qq
Kelm -ate._ 5-Etw AtAtor�ia+ e .o
Fre_ vtc l-e.r S st-ti -a-arol�(otdt
't a'€, evl,,va, .5,Ace_ , - NFP ' 1 , / -
Ma,rsLla .
PROJECT NAME(Name of Business or Owner Last Name) (f 4 C 1' .5
/ ii V• PEOPLE INFORMATION
PROPERTY NAME wLPRIMARY PHONE
OWNER 0 511 ore. t 164e,adgQ. Ra vi Q/SQ ivi€44 (Z44,)671 - 560
MAILING ADDRESS C11Y,STA ZIP
PO box 77735 .attke_, WA "177
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Moore F're Prote_c±o t Niattlfiew 5 e_ X7'7 ('1Z57 ( - 5518
MAILING AD
i L7 G,z tDRESS 5 r< Mai �l�l l e� KJ. CITY.STATE.ZIP
��(a�l, WA
?°2 f (ELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATIION DATE FAX NUM)BER
C 5- I 0 - 5 a0 , 0 °DM L / / (1126)Z71 - 5506
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
M0a KEf P l t 6, N f 81)44(1 (2 / -51 /Zoto
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
Moose. Fire rroted.iavt Ntatt,€,v 5tee le_ ('IZS) Z71 - 551$
MAILING ADDRESS CITY,STATE.ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT l FAX NUMBER
a Architect a Tenant ❑Agent Other(Describe)Covtrac€o( (y25) 17( -55o,
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
Ma w,,, 5tegit_ (1125) 17( - 5518 MAtt seivemoo are°-Cco.
LENDER Per RCW 19.27.095: Lender information is NAME
required(f project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
Q I • DETAILED BUILDING INFORMATION
EXISTING USE ri eta i` 3tC✓c _ PROPOSED USE C.Ja S$r IO fri/C i&1
6
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ , 1 5 f •Oo
SPRINKLERED BUILDING? )(YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES a NO
WATER SERVICE PROVIDER a LAKEHAVEN a HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN a HIGHLINE a PRIVATE(SEPTIC)
1110 •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. Sg.FT.
BASEMENT / Q,, 6,,c(-5q i
FIRST det5.5 U?!ti7 S Avid cG (le.. it 1(O70
SECOND �l
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS EXITING PROPOSED rol
rAc TOTAL Eztsrnvc SF ,r6OiTro$wG( gr irgr �
**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(Toilet) —55 MISC(Desc 'be)
DISHWASHERS SINKS DRINKING FOUNTAINS Seri lir 144:45
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS)Bathroom Sulks) 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. � l J( b l/
NAME/TITLE - //d '- '" G2 ' /1
DATE Zo 1 O
(Signature) ('rile)
RELATIONSHIP TO PROJECT ❑ Owner 0 Agent Contractor ❑Architect ❑ Other
FOR OFFICE USE ONLY
❑NEW o ADDITION ❑ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES 0 NO
PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100—January 7,2005 Page 2 of 4 k\l-Iandouts\Permit Application