05-101038 'MAR-t:-2005 08:08 FROM: T0:12538352609 -.3
.140%��.7Lr�t1t
CRY Of IA . 0
Federal Way PERMIT .0.
COMMNTYDEVELOPMENTSERVlCES SF MF CO 15, LPL DE EN FP
3332S try AYMIMUR SOUTH.PO BOX 9715
FEDERAL2WAY,
;rAXzs3 z APPLICATION - TO
wwwotuo fedanhaau.wm
The oiiowd • is re•aired i ormation-art roto •tete a••lication uliki not be acce•ted. Please •rint le.ibly(in in or • .
• •PROPERTY INFORMATION
SITE ADDRESS q 3 I S z c q / sI I, SUITE/UNIT#
L -7
ASSESSOR'S TAX/PARCEL# 5 ✓ ` v
e r- iin 7 0 LOT SIZE(sn
t
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) I
Mao*s g.pbw/wLengd+9 -• der:40al
s •_• ■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMB a (GI iECHANICAL
0 DEMOLITION 'ELECTRIJCAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on • ermit on
• l elsS-iI[ I r 7...-, fl r# Of rce 1 it /i '
PROJECT NAME(Name of Business or Owner Last Name) De.4)4 in
• al PEOPLE INFORMATION _
PROPERTY NAMEI � PRIMARY PHONES
OWNER p pvJc, �-eL 34 (ZS?)K "6703
MAILING?� r ADDRESS6 J CITY,STATE,ZIP 414- 9
CONTRACTOR COMPANY MEAPPLIFANT NAME OFFICE PHONE
W4.sh. t 4-i1C01 C41-t_cteL. 4e-e) te--- 1/7a6
'2MAILINNO ANDD ,Cg.:02...-STAylt CELL PHONE
CITY OF FEDERAL WAY BUSINESS L NSE NUMBER EXPIRATION DATE FAX NUMBER
-03_-J4)""L2=3 V__B L I L / e dor ( ) -
CONTRACTORS REGISTRATION NUMBER(copy of card requited with each application( EXPIRATION DATE
bu14fK t GS' 7 /O a I q / z /4t'
APPLICANT COMPANY NAME APPUFANT NAME OFFICE PHONE
MAILING ADDRCI , AT , P �h� - .CELL PHONE
7.--,b0
/baP TO PROJECT Aj�•� I •
(F 1?/ ( ) -
FAX NUMBER
o Architect 0 Tenant Agent 0 Other(Describe) ( ) -
CONTACT NAME \``rr ate► Cn r� PRW—)7qU -7 E-MAIL ADDRESS
LENDER k 'r.. *• NAME21f'
��-*,�yv+� 7 r• LeA •eri�efbrntaHoN fe
re mid.ip fa 1.e, "" eds$5 OOOt i
MAILING ADDRESS CITY,STATE,ZIP
,. •,. ". .- • DETAILED BUILDING INFORMATION • * •
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ 1/41ILUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES a NO FIRE SUPPRESSIO SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
. WATER SERVICE PROVIDER D LAKEHAVEN 0 HIGHLINE III TACOMA CI PRIVATE(WELL)
SEWER SERVICE PROVIDER O.LAKEHAVEN a HIORLINE G PRIVATE(SEPTIC)
1
MAR-?••2005 08:08 FROM: T0:12538352609 P.5
•
•- . PROJECT FLOORAREA((S • •
AREA DESCRIPTION EXISTING SQ.FTJ PROPOSED SQ.FT. TOTAL
/BASEMENT I -
_FIRST •
SECOND •
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
TOTAL Lz'zruo I TOTAL►ROIOSeo TOTAL uu TWO ANO r•RO►O•So
HOW MANY FLOORS?
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $_
_ : •• _ = . _ -.. •-: :•-- -� -FIXTURES ', - - � :�:. .. �:- '. :. •:
Indicate number of each type offixture to be installed or relocated as part'f.this project. Do not include existing fixtures to remain.
MECHANICAL � •
Value of Mechanical Work $ O( t•(p3• cc
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS
REFRIO.SYSTEMS
BBQS FANS HOODS(Commercial) WOODSTOVES
BOILERS 1.0" FIREPLACE INSERTS —1 .RANGESMISC(Describe)
COMPRESSORS FURNACES I GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING •
MISC(Describe)BATHTUBS(orTue/shmAsrCombo! SHOWERS • —1 WATER CLOSETS frothy
DISHWASHERS SINKS DRINKING FOUNTAINS
CAS PIPE OUTLETS SUMPS RAINWATER SYST -
WASHINO MACHINES - .URINALS __t• HOSE BIBBS
LAYS teauRoomstlll it s VACUUM BREAKERS ELECTRIC WATER HEATERS •
_—_.
DISCLAIMER/SIGNATURE BLOCK- 1- • - - - '
I certify under penalty of perjury that the information furnished by me is trice and correct to th!bestaof myis rna owl el e,and
rte further,
?that
l I
am authorized by the owner of the above premises to perform the work
,nd h attorneys'the
permit
application
in the de.Investigationrhe and hold
harmless the City of Federal Way as to arty claim(including costs, expenses,ed dd tney 'fthe sCincurred of Federal Way,but only where such defense of
such claim), which may be made by any person, Including the undersigned, �Tagainst
m
arises out of the reliance of the city,in ing its officers and employees,upon Ithe accuracy of the information supplied to the city as a part of
/ c -?3++I ieIthis application.
NAME/TITLE )"' d DATE /71Ar
(Signature)
RELATIONSHIP TO PROJECT 0 Owner i t O Contractor ID Architect O Other
ik
k
' :
•
. o NEW o ADDITION o ALTERATION a REPAIR I iiTENANT IMPROVEMENT
BUILDING SHELL ONLY? 0 Y.ES 0 NO . B SIC PLAN? o'YES a NO.
• • DESIGNATION C• GEOF_USE? • oYES o.NO
• . - • • • U^/SEPA/SU?. o YES o NO
PLATTED •T? a YES o,NO D MO PERMIT REQUIRED? o YES o NO
Dtco' 43 q' s SI"
1
•
c 2 of 4 I k\Handouts–Reviscd\Pcrmit Application
i
Bulletin(1100–March 30.2004 — • Pa S
I