06-101953 I q )a3
RECEPED
04CUTOF 41111A
Federal WayLo.,___Ii----3
OOA1FUNrYDEVELOPMENT SERVICES
A P R 1 9 2006 PERMIT SF MF CO ME EL PL DE EN lt'•
33325 8TH AVENUE SOUTH•PO BOX 9718
FEDERAL WAY,WA 3.9711 )TY OF FEDE PLICATION
im
253-8354607.PAX 253-8354609BUILDING
yvww,dtwffedemhaati.corn
1 The onowin• is re, fired information-an inco •late a• •lication will not be accepted. Please •rint legibly in in or 1• .
■ PROPERTY INFORMATION
•
SITE ADDRESS 312/1 p4C1 I )'C ,, - SUITE/UNIT
ASSESSOR'S TAX/PARCEL I - LOT SIZE(sfl
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
/Attach a/par/apNafar lengthy legal dosed/Wan)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING IRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
f 'TYL*< > ,_clitgite5c10i7 -5/Witfl
PROJECT NAME(Name of Business or Owner Last Name) 1<b r. -0 LA <- 0—yi,,,,,,)<e)
a PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER ( ) _
MAILING ADDRESS CITY,STATE,ZIP
CONTRACTOR COMPANY NAME APPUCANThNAME GEEK ONE
NA \N� DIY�" tt r�le� Flp to ��,) ? -0l 'TE,cgticP• CELL PH NEJ L
OF FEDERAL WAY�3�ESS NSE NUMBE 1 r�EXPIRATION ATE 174 N SR /
2 --0�-1 QL B L • / / ( ) -
1CONTRACTOR'S R ISTRAT N NU BSER ,es card ragairad with each application) EXPIRATION DATE
11-""5- ` — I C / /,..,,LO
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
MAILING ADDRESS ce.(114:Q_____ CITY,STATE,ZIP CELL PHONE
( ) _
RELATIONSHIP TO PROJECT FAX NUMBER
a Architect 0 Tenant a Agent a Other(Describe) ( )
CONTACT A,A,e� I I Pm PHONE E-MAIL ADDRESS
LENDER NAME
MARINO ADDRESS CITY,STATE,ZIP PHONE
. ( )
• DETAILED BUILDING INFORMATION
EXISTING USE l o v 4L PROPOSED USE 47,4
`✓�1ik a y„
EXISTING ASSESSED/APP SED VALUE $ A?"--
VALUE OF PROPOSED WORK $ 42073 6o'°
SPRINKLERED BUILDING? a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑4S a NO
WATER SERVICE PROVIDER LAKEHAVEN a HIGHLINE a TACOMA ❑ PRIVATE(WELL) /
SEWER SERVICE PROVIDER LAKEHAVEN 0 HIGHLINE a PRIVATE(SEPTIC)
• �►
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
a
FIRST
SECOND
THIRD
FOURTH
•
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
LUSTING PROPOS= TOTAL
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 fixtMres to-remain.
MECFIANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
_ BBQS FANS HOODS(c.mmad.q WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING '
BATHT1JBS(oe ub/shows Combo) SHOWERS WATER CLOSETS Rao MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(eathrsom shy VACUUM BREAKERS ELECTRIC WATER HEATERS
•
DISCLAIMIER/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 e •!ogees,upon the accuracy of the information supplied to the city as a part of
this application. •
/�
NAME/TITLE �� L DATE !� /Y.�v
- ignatu (Title)
RELATION i i v • PROJECT 0 Owner ' - t • Contractor 0 Architect 0 Other •