06-100168 VOW III \-roi f
0,_.•& fa& - � Z2 .0i _6
Federal Way PERMI10EIv ED
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE ��P
33325 D AVENUE,WITIi•PO971 9718 APPLI CATSN 2°°6 `
FEDERAL WAY,WA 98063-9718 "� /
253-835-2607•FAX 253 835-2609
www cliuofederalwau.com
CITY •F FEDERAL WAY
The ollowin! is !uired i ormation-an incom,fete a! , is-_;1,: 6,,,,r. ;A;ec:�• •ted, Please • nt le' •1- (in ink)or .
6 l Ave,• PROPERTY INFORMATION
SITE ADDRESS 3 31 1 O 11 k A ,(,..0u-ilei p SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# l 7 Z ) 0 4 - ( 1 3 Q LOT SIZE(sJ)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESC' +' ION(Provide det. •d description o work include on this permit only)
- O✓l • Cs^-4 f o ✓1r - J44
V
JZAT-eleffte;1/1 -3 4111%-/441404V-144.) '
PROJECT NAME(Name of Business or Owner Last Name) TeAe V.Q 1 LIQCa WL N1 LC1A l ( , Ce o q e,
.,
t(♦ PEOPLE INFORMATION
PROPERTY NAME PHONE
OWNER MAILING.
C 1 I+4 01-
J e e✓e Wald a d (� )&J3 - 6, 9i oz
gLo. i3 c)r q7 IS-ADDc edge vaI 1 i/Q / W �i�i 00
CONTRACTOR COMPANY NAME l APPLICANT NAME OFFICE PHONE
Coco- tt Pro-!CG/i e,1/l %lieSC.f S (Lf 5)sa 7 -45y
MAIlOLF G I® F
/ ZIP
E PHONE
4fDRESS 117-11 a C I\1 rTl(v'[ Q YV A / 03.3 ( -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
a Q- o L -1 Q 1 8 e q-B L IA_/3 / /06 WS )8017 - 7g7't
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
CO ,S C oT. P 11oNl,� 1/13/01 --1.2131 /&6
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
Osco .- ; de Pr6 ec4io✓t Sock ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
5q$41G ( )
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent ❑ Other(Describe) ( ) -
CONTACT NAME (' PRIMARY PHONE E-MAIL ADDRESS
�4 ICG is
5 f (K�S)8�7 - 46 � 85((SSepCoSC04-4,e- ,,,..t
LENDER Per RCW 19.27.095: Lender information is NAME
required(fproject value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE —v PROPOSED USE C0140114✓I t/ j Ce41C V
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ '104//0 46,00 TO c' ,re
SPRINKLERED BUILDING? )(YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? X YES ❑ N
WATER SERVICE PROVIDER (LAKEHAVEN ❑ HIGHLINE ❑ TACOMA O PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN O HIGHLINE 0 PRIVATE(SEPTIC)
11111111.1r •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOS' D TOTAL
SQ.FT. SQ. . Sq.FT.
BASEMENT
FIRST g
SE IND 57, 6 ‘ "
THIRD 6/ 5!
FOURTH
ADDITIONAL FLOORS .ESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS =ATM PROPOSE) TOTAL row,COSTING Ir TOTAL PtOPOS"IF Ci
m�a /
••NEW HOMES ONLY** NUMBER OF BEDROOM ESTIMATED SELLING PRICE $ + [ [
FIXTURES
Indicate number of each type of - to be installed or reloc. =. as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS LOGS REFRIG.SYSTEMS
BBQS FANS HOO a Commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSOFURNACES GAS WATER H.+TERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BA•• BS(or'Mb/Shower Combo) _ SHOWERS WATER CLOSETS(roueq MISC(Describe)
SHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLI.lb SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom 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 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 ' y person,including the undersigned,and filed against the City of Federal Way,but only where such claim
arises out of the reliance of the / lading its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application. (� /�j l
NAME/TITLE At../.4_ I'=�— Y, I(K�(`/ �tA��yti! DATE 0 1 1 0
(Signature) (Title) ) to
RELATIONSHIP TO PROJECT 0 Owner 0 Agent 0 Contractor ❑Architect ❑ Other s(C[J CO Irl, rC ✓�
FOR OFFICE USE ONLY
a NEW in ADDITION a ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? ❑YES o NO
PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? a YES o NO
Bulletin#100-January 7,2005 Page 2 of 4 k\Handouts\Permit Application