07-103533 roo\-t\A\ )a 7-e_
_ ( 0
Federal Way # E'j
�� 3
CEIVEgERlVIIT SF MF CO ME EL PL DE EN COP
CDMMUNITYDEVELOPMENT SERVICES
33325 FEDERAL
.WA H9•PO BOX 9718 N APPLICATION 4._ _________ /
FEDERAL WAY.WA 98063-9 718 �'O
253-835-2607•FAX 253-835-2609 JU 2007
www.cityoffederalwati.com
The following is requil pr y"ran incomplete application will not be accepted. Please print legibly(in ink)or type.
r
II PROPERTY INFORMATION W
SITE ADDRESS 35' "I S . I - QA) r le i'C( A/6 4• Z SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# / 3 Z ) C - j. _L C) 7 -__0 Z LOT SIZE(sJ) I Z.)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) Nord jfh((r V I l I vt c'(
(Attach separate page for lengthy legal description) ()
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING pIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
rt. r"4-a k•�I e - (Tyr- f Zt 1 l LAt4 rL(r j r(id— S
,(-4(151-1-ey-t___ ti,11
0
PROJECT NAME(Name of Business or Owner Last Name) 11 • •Ow. g40
• PEOPLE INFORMATION
PROPERTYN �nI PRIMARY�IPHOONEE
OWNER Y►/l ')I eY1(( T 1uVYlbc > ( 2LW `l41 - (c25 2,
MAILING ADDRESS STA ZIP E-MAIL ADDRESS
L `GIC1--c ` ,,k16 m f3 tie r-4Lo ,0/ii ,q.LC
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
11160re i'-e Prb� 6---hc i Iheri V' r � ( 1--17_9-271 - 55-5c/fs"
MAILING
I �ADDRESS,FEDLRAL WAYUI' ISINE �I�(/1 1' MENE CCELL PHONE
.S, .Zj tU r N DA1•E4 1(O&c 7 'iZ NUMBFAXE�l - 13 2
20 --0.7 — ;co I CC --CC: - E L_ IL'31 l,`7 (`t -5) -Z71 - c55
COPS of card requited CONTTRAC'IOR'S REGISTRATION NUMBER EXP RATION DATE E-MAIL ADDRESS
with each application b i I c/ 'I/EP P 1'Iso a
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
I' ' (V3\(( f'(rt,. PO r(--.fe), ) M me; ( CAViit -
M�AAAIIILI G ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT 5Yv}i 1 FAX NUMBER F l -
Architect 0 Tenant o Agent [;Other AAb CC,'i"ftWACAZ'V'" ( 6:-(ti)Yill
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT YV rt 0 3 cvir > (L1Z.5 ) 271 - CSci ' IAN o j&I Y i-, 'e--1i ,1:00/
LENDER NAME 1O/A Per RCW 19.27.095:
Lender information is required(f project value exceeds$5,000
MAILING ADDRESS CITY,STA ,ZIP PHONE. `��
1�ij- 11A- ( 11N -
• DETAILED BUILDING INFORMATION
EXISTING USE N r vy X11 I l 1 l/\C1 PROPOSED USE 2-c i I P.c y-�
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 3-1)S 0 0 0 CC
SPRINKLERED BUILDING? 'YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? q ES 0 NO
WATER SERVICE PROVIDER J.AKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ) AKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESC' I' EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT NA A
FIRST OC
_,C-�
SECOND l 21 ll�
NA
THIRD J, ± ++A�
ADDITIONAL FLOORS(DESCRIBE) A 1
DECK(El COVERED OR ❑UNCOV D?)
GARAGE ❑ CARPORT ❑ nl
1�+i EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**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$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SEIb REFRIG.SYSTEMS
PLUMBING v
BATHTUBS(orThb/Shower Combo) LAVS(Bathroom Sinks) URINALS (( MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS rJ _
DRINKING FOUNTAINS SHOWERS WATER CLOSElb(Toilet) �t�'( j 90-1(1(In-
ELECTRIC
WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS 6TYisk'11
SIGNATURE
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. ( J �j
NAME/TITLE , (�' r ice_ y�1S�CV1 I DATE /Z /o
( ig�nature) � (Title)
RELATIONSHIP TO PROMCT 0 Owner .Agent 0 Contractor D Architect '. Other
FOR OFFICE USE ONLY
o NEW ❑ADDITION ❑ALTERATION ❑REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES ❑NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? o YES ❑NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? ❑YES o NO
Bulletin#100—April 2,2007 Page 2 of 4 k\Handouts\Permit Application