05-101513 A /;. -,,,_ . _
0,
Federal Way 0 Li/
/�p PERMIT FP
QOMARUNTYDEVEIAPMEM'SERVICES� SF MF CO®EL •iiiip 33325 6^•AVENUE SOUTH•PO BOX 9714 1 ,FEDERAL WAY,WA 1d -005Lei .oArTION TD 253-d35-2607.FAX2� APP www.ataolkdetdwaQ J/L EDERA`The ollowi . is -•uid in•�iattion-an inco •lete • ••lication will not be acce•ted. Ple• - ' t le• '
IN PROPERTY INFORMATION
I 377 5 ,7' S II
SITE ADDRESS .,
ASSESSOR'S TAX/PARCEL# - _ _ _ _ t LOT S
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) 1
Pitted.sego ole P.9 ft,toffy I.9.1.— 2 .
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILD ' ''',7,PLUMB'
0 DEMOLITI• h • ' CAL 0 ENG. 11 G 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of wor ud• onl
\\ (6\V\
PROJECT NAME(Name of iness or• Last Name) ` ';i f\G U 'a-\f/' M
MI PEOPLE INFORMATION
PROPER ' NAME `
// / / �/J PRIMARY PHONE
OWNE• / ,'j !� 'C ' r/t o'7�-cssU (2.- , 3 ) 5(3g sl�3
VA
CSC,
MAILING ADDR S CITY,ST E,ZI
CONT• COMPANY NAME APPLICANT AME
OFFICE PHONE
gv co va n / .a..7):1y r c'c: i4., C�/'-. 'K (90 ) YG �'l13
MAILIN ADDRESS CITY, ATE,ZIP CELL PHONE
r5D te/� e- f{ (6 /Y-4-07, f .+e te4ii 71? /2 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
-s L / / ( 3‘0) q06 -083 f
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
Scc. e_ ( )
MAILING ADDRESS CITY,STATE,ZIP - CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect 0 Tenant ❑Agent ❑ Other(Describe) ( )
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
doh„ G//:A4& (2-13) q$ //"r0
LENDER 1.,<::�Ra4^,4.1;';, /,1-,4,x r• -d. NAME
'f.,tk.- li,; � .':y .3. 62- 0:1 . :
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES 0 NO
WATER SERVICE PROVIDER a LAKEHAVEN ❑ HIGHLINE a TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN a HIGHLINE a PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
1SQ.FT. SQ.FT. SQ.FT.
BASEMENT ..rte
FIRST 1
,t..
SECOND
THIRD 'E,, i
FOURTH . •
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
'44i
=STIES PROPOSED TOTAL :r7m tAsivto sr ,TOTAL PROPOSED sr ' -4',..-,'1A; ,-TOTAL sr
NUMBER OF FLOORS fr;_>" ,-' -, ' ; `. '':•:•••-4;?
••NEW HOMES ONLY" NUMBER OF BEDROOMS :ill 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 0 �� . ` I;
Value ofMechanical Work $
It
t. AIR HANDLING UNITSEVAPOjRATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS _ HOODS(Camme.64 WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC i scribe)
COMPRESSORS FURNACES GAS WATER HEATERS i► . P
DUCTS GAS PIPE OUTLETS / .
PLUMBING 414444,
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS(toilet) MISC. lescri. .
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST ' 1
i
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sides) 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.
NAME/TITLE E'er' Ll/ �"�a�'�J DATE I —/ — v�05
(Signature) � (Title)
RELATIONSHI• ►s PROJECT ❑ Owner la'Agent 0 Contractor 0 Architect 0 Other
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