05-101133 v� )S%Lq
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CITY OF
EGA' • _ c0 ( / 3
Federal Way 2005 PERMIT
COMMUNITY DEVELOPMENT SERVICES MAR 1 SF MF CO ME EL PL DEE FP
333?5 871,FED 35-ENfIE SOUTH•AD BGX 9718 EA,tP L I CATION
/ /
PEDERAL WAY,WA 98063-9718
153-835?607•PAX 253-835-?60T 1-TY OF F E
mru,lTun:feaeimmau La, �,! BUILDING
The 'Ifo , , is tre • ••• • -an • •fete • .•licatton will not be • . • Please , • ar +r•
PROPERTY INFORMATION
SITE ADDRESS 34100 (D Ave5, SUITE/UNIT I
ASSESSOR'S TAX/PARCEL it 1 Z (o 4 S 0 - O O 1 O LOT SIZE(s)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) JET A�Ac.:44 E)
(Auoeh aTPoTTItcPvzfor Ing++w 7eyat deavtpeonJ
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
It.15TAR1)11ot i or prof-IAnc nee SPgliJKckg., crl
PROJECT NAME(Name of Business or Owner Last Name) FC DE(2AL At/ AI-18ULATO(Z`I Sop_66-124 CENTSg,
PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER F W ASG LLC ( ) -
MAILING ADDRESS CITY,STATE,ZIP
P b. )3O' &iO BLAc -DtA fOiJD, WQ c15O Ib
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
A4.E nee P2vrccno,J S,-rsTcr(s 6e54 I'1OFFErT (4Z )4Z - 4401
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
232Zo NAPc.E VAtkE/ Y 6 3D )•'IAPLE VtktA_E-/ cj5()38 ( 2o',) 341 - 1704
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
2 0 - O 3 - i b f '1 8, 8 -BL I2 / 31 /o (425)432 -049.4
CONTRACTORS REGISTRATION NUMBER(copy of cord required with each application( EXPIRATION DATE
ACEF 1 P S ) 4 -I P I
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
5A4-ie As Ae,ovE ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect 0 Tenant 0 Agent $.Other(Describe) 5 J 3(-Krre-A i0( ( ) -
CONTACT NAME PRIMARY PHONE
E-MAIL ADDRESS
(.12.6-6 f✓IaFren' (425)432 - 4401 9moffcf+(aref're.net
LENDER ler ROW 19.27.095: Lewder information is NAME
required if praject value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ L 4 j ) O C7
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
• •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS RUSTING PROMO= TOTAL TOTAL ssrsmker TOTAL 1.5Wv
OPOw TOTAL
"NEW HOMES ONLY*' NUMBER OF BEDROOMS ESTIMATED SFI LING PRICE $
FIXTURES
Indicate number of each type of facture 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 WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS nuTub/Shower Cmho) SHOWERS WATER CLOSETS mono MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS path.00n sinks) 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 authorised 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 ' y v-p. DATE 3 -I(- 4>s
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent R'Contractor 0 Architect 0 Other
FOR OFFICE USE ONLY
❑NEW o ADDITION o ALTERATION ❑REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑NO BASIC PLAN? ❑YES a NO
ZONING DESIGNATION CHANGE OF USE? ❑YES n NO
NEW ADDRESS REQUIRED? a YES o NO UP/SEPA/SU? ❑YES o NO
PLATTED LOT? o YES ❑NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100—August 19,2004 Page 2 of 4 k\Handouts\Permit Application