06-100982 •
DECEIVED
SG
Ocrn of 1 �y
Federal Way PERMIT -- lJ ("
COMMUNITY DEVELOPMENT SERVICES.' SF M' CO E EL PL DE EN FP
333258TMAVENUESOUTH.POI?DX971A o 2 eon APPLICATION n �%
FEDERAL WAY,WA 98063-9718 /
253-835-2607•FAX 253-835-260F,,,�`EDERAL If .
www.dtuo((edemhoatt.so AY /
I 1
JUILDING DEM
The following is required information—an income lete a e plication will not be accepted. Please print legibly n in or type.
.. ■ PROPERTY INFORMATION
SITE ADDRESS " a�Jl� E T £A� SUITE/UNIT# r-
ASSESSOR'S TAX/PARCEL# 72-c 0- CO 2 0 - LOT SIZE(s) I 4'7i 4-54-
LEGAL
5-7LEGAL DESCRIPTION (e.g. Arnie.Estates,Lot 1) [.aT .2 67` WL 'T C,Gos offIciE /4' o/y/55/oAJ 7
(Attach separate page for lengthy legal descnption)
'` ....■'.PROJECT INFOR14iATION
if C.C_
TYPE OF PERMIT BUILDING 0 PLUMBING ❑ MECHANICAL
If
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
6N.± -7--C _y ,/ -CL . 3- SF-
PROJECT NAME(Name of Business or Owner Last Name) C/`}M Pu (dI AIDE fc:71Z,f SSI o N AL 1�'K, .
t
' '� PEOPLE INFORMATION °
PROPERTY NAME
PRIMARY PHONE
OWNER
" {'RK- --rule-ry 5(•014 LLC (if e-S) 775 - 6 552
MAILING ADDESS CITY,STATE,ZIP
) WI 9d- , N. ,Et9ivv Al)()-5 i w� `c 02 0
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
(3(?GIE/A c.cgE TE ( 53) 92Z - 3375'
MAILING ADDR S CITY,STATE,ZIP CELL PHONE
&b. VA-I-c5 ilivr— N.CJ . 1744?"5-6Lu _! 14)/3te32f ( ) -
CITY OF FEDERAL WY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
B L / / ( )
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
A GC. g E C—c- 77 , N P l l
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
M- H /C-AndoCWrIrc--I U•.'fic)3'I3'1gL I-4o1/1-Afr.-4:3 (2.53) 344— - 7,5.-1Z
MAILING ADDRESS , CITY,STATE,ZIP CELL PHONE
o /'
2 c ic 1�21O//f� (g v a /Lro'vl r.J/1- b'3 --9 (2.53 ) 3¢4 - ?5,I z
RE TIONSHIP TO PROJECT FAX NUMBER
chitect 0 Tenant ❑Agent 0 Other(Describe) ( ) -
CONTACT NAME PRIMARY PHONE E-MAL ADDRESS
l Cl�'7 L vUir
!—fv �O (Z-53) 30.- 151 z- ei o\/cw �
C,
.4 4-
•
LENDER ,N eWi0)`.✓ 4 ,010) #` J ii`x NAME C_6/It C_a'S • n c
Q
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
I I',DETAILED BUILDING:INFORMATION
EXISTING USE VA's-CA/sir- PROPOSED USE C(1`/C-LC_$
EXISTING ASSESSED/APPRAISED VALUEXN0
$ o '(13:-../ ¢'-'u VALUE OF PROPOSED WORK $ 200 2 i ii;
SPRINKLERED BUILDING? 0 YES FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES t ,NO
WATER SERVICE PROVIDER XLAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER '0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
• •
PROJECT:FLOOR AREAS = •
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ. FT. SQ.FT.
BASEMENT
FIRST ---al 32,5v --3-z 6-0
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
7rROeossn
NUMBER OF FLOORS c=>N o N E
Iw .,.W
IVEHOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES- . `. 1
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 it ooGit7? s94 ti ?r Ux-) T.I,
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS 1
BBQS FANS HOODS(commercial( WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe) 1
COMPRESSORS FURNACES GAS WATER HEATERS 1
DUCTS GAS PIPE OUTLETS
PLUMBING I
BATHTUBS(or Tub/shower combo) SHOWERS WATER CLOSETS maksMISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS a
GAS PIPE OUTLETS 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 any person,including the undersigned, and ftleit 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 /C/� � � � l-fjJ5 t- r
DATE (73. 2. o
/ (Signs re) t (Title)
RELATIONSHIP TO PROJECT CI Owner 0 Agent 0 Contractorlip' .chitect 0 Other
x .n. ,.,-',;,0,1"t,,4; a. a 1. a
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