07-103752 ..AC!TY OF
Federal Way REc v - L Q, . 7
PERMIT SF MF CO ME EL PL DE EN FP
COMMUNITY SERVICES
33325 811,AVENUE SOUTH•PO BOX 9718 "L 1 0
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FEDERAL WAY.WA 98063-9718
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253-835-2607•FAX 253-835-2609
www.cihtoffederalwau.eom °q R' RM M►4►`�
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The following is requirqqUW Oua rmation-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION /�
SITE ADDRESS 35 41 5_ I-)sr - v•e �.W Fedo'a�14uALy )WA •C7 W-) SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# Z____!:"") . Z ' (' 3 - 90o / -02_ LOT SIZE(sf7 IL)COO
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) 11Ot''IVI SVlQ(( - 0 4 la
(Attach separate page for lengthy legal descnptton)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL j
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING ) FIRE( PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
re_ `:. n1P\1'71,i" Yri -) 1I
PROJECT NAME(Name of Business or Owner Last Name) Kj )ri-ifShtn-e V..
li\Q • '
NI PEOPLE INFORMATION
PROPERTY NATI r^'"onv PHONE
OWNER T�C ' +._ par47i
1 'i J C ZJ
Z
T --sir:A.......,„„
("'^' cTATE.ZIP E-MAIL ADDRESS '- —
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
1/1001ecf,17‘re.,Prot aiIYci tvy VIVI JC IC5 ( ) Zj - 51?
MA�IILIING'ADDRESS
�}+' '�(V/,�` �rZ/) CIITTY STATE,
r�ZIP r '�'J�`�// CEE L PHONE PHONE C�
111Y OF b WAY I MUSIN LICENSE I I�I1BER 61 .114/J i r�OI�DATE F j5 E ' tl - Jq6✓
Zo ^o i - 10o)05 -Ulf -- 61— 12--76I)0-7 ("Z7) z7 - SSOlO
COPY of card required CONTRACTOR'S REGISTRATION NUMBER EXPIRATIONg'', 1".-.M
� DATE E-MAIL
E-MAIL ADDRESS
with each appllcanoa l� Ili b^yi E_ +� j), ^ NIP [j',1„-M
APPLICANT COMPANY NAME r W +v APPLICANTNAMEX/ ITL OFFIC PHONE
niCeit Pi rc Poi .-hOv1 ..t ( �rnn,-
'lf/IADDRESS
Vl I f� IP CELL P �1r Y 1�-
RELATIONSHIP TO PROJECT nl(�f FAX NUMBERP
0 Architect ❑ Tenant o Agent [Other , lA l if 'V ( et/
e----
PROJECT NAME PRIMARY PHONE
(� E-MAIL ADD3ESSS
CONTACT rVy h1() ' Cnlc. ('/Z ) 7 I--r_ 1 My Il✓Ij 6 i iM
y,e,- I�i add
LENDER NAME ,vit Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY, {STATE,ZIP PHONF�
N/1 NA ( N
�A ,n, ll • DETAILED BUILDING INFORMATION I G
EXISTING USE IOC lam'V E(,11'of PROPOSED USE I G I.1 1 S�i ex
EXISTING ASSESSED/APPRAISED VALUE VALUE OF PROPOSED WORK $ 5-7) 500 ,00
SPRINKLERED BUILDING? YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?\] YES ❑ NO
WATER SERVICE PROVIDER )&LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER *AKEHAVEN ❑ HIGHLINE o PRIVATE(SEPTIC)
MI PROJECT FLOOR AREAS
AREA DESC' i 1 EXISTING PROPOSED TOTAL
BASEMENT SQ.FT. SQ.FT. SQ.FT.
Nyl-
FIRST
SECOND nV1 I�,00 U
1k}
THIRD
J� 'Ii
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR 0 UNCOVERED?) A)a
Vi
GARAGE 0 CARPORT 12N A F v
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
"NEW HOMES ONLY*" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
II FIXTURES
Indicate number of each type offucture 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
DUCIb GAS LOG SE:lb REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS r
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toilet) (e...GJpn� )C-`/
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
-ThSta. I I
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.
NAME/TITLE I A� [/ Gt/TiJ•r / ATE 1(010-1
1(Signature) Mlle)
RELATIONSHIP TO PROJECT ❑ Owner Agent o Contractor ❑Architect 0 Other
FOR OFFICE USE ONLY
❑NEW o ADDITION o ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES ❑NO
PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? ❑YES o NO
Bulletin#100—April 2,2007 Page 2 of 4 k\Handouts\Per lit Application