06-100980 w
r
Al° • ,
4Acar or Q Co - V
Federal Way /� p PERMIT
COMMUNITY
AL WAY,LOPMEN 63-971 CES MAR O �r SF MFS CO E EL PL DE EN FP
.. 3258Th AVENUE SOUTH•PoBOX 9718 APPLICATION � �
FEDERAL WAY,WA 98063-9718 �
253-835-2607•FAX 253-835-260let9 Le` '
wrow.citya(Ierlemhuntt.wm {4iNG La-. .
The following is required information-an inco •tete a••lication will not be accepted. Please •rint legibly in in or type.
<~ // f�• PROPERTY INFORMATION * --
SITE ADDRESS (fl�b 456-7-4'3 fr 1`�----51r-AT ��OSili///' �e S S SUITE/UNIT# E
ASSESSOR'S TAX/PARCEL# 67 C° - 0 0 2 6 _ (O l¢ql 4 G 4
— LOT SIZE s I 1 `T
LEGAL DESCRIPTION(e.g. Acme Estates,Lot 1) L o 1 '2 `N' W-› C/ r''I/�c.15 c f fi� n/''4' a(y(S/ono
(Attach separate page for lengthy legal description)
PROJECT INFORMATION
5)-tELC
TYPE OF PERMIT DOUILDING 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 onlq)
O N4 S1ofl`f .5i-JC-c, 325-0 5 f_
PROJECT NAME(Name of Business or Owner Last Name) G6c/'41115 Po/kid ta(Z°j-655/0AJA,L_ eAg
€ PEOPLE INFORMATION. .
PROPERTY NAME PRIMARY PHONE
OWNER 771E. -f-i ,ei—( slX L.C, (.- (4S ) 77`-� -65-52
MAILING ADDRESS t CITY,STATE,ZIP
i G1l cfra - Aub, tjog * 1::01-10AJOS, cvA Q v62a
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
/3(2c-VAC .fir (253 ) 42 - - 33gij
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
C(-)(: YP'1-LE'f AV;c- I.)•w. Pc‘rfct..ug, 0-in- i 2 5 4 i ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
- - _ / / ( ) -
B L
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each appllcatloni EXPIRATION DATE
_Act.4E c 9(7 3N P / /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
M.• Pi-CAL t_A...4 P1260):l a Ni/C--Mt/ C- i�ON/c-A31,), (0-53 -7 5 1
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
roo it,(4 1,19N J� (4B8) m/Grog Wig 7v 5f- (25 3 ) 3g 5- - ?G¢Z
RE TIONSHIP TO PROJECT FAX NUMBER
hitect 0 Tenant ❑Agent 0 Other(Describe) ( ) -
^<ONTACT NAME PRIMARY PHONEE-MIL ADDRESS
NfiC'-' _ /-4-o/tj4A)0 (4-Sw .) ' -314 .��Z 0Ygri✓�, t
TENDER 04401)VO ;1°74 ' + - ` NAME 6 wN (2 Q ovevI C A-5r•Flo r
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
: ' G '-':"":;:':'`''1::':':t'!:r.''''- ''''''''''''''''''''' ''''''':''' ■ `DETAILED BUILDINGINFORMATIONI.: u 0 4.z + i
,t r
EXISTING USE "l CI / PROPOSED USE dr-fic f-C..5
EXISTING ASSESSED/APPRAISED VALUE $ gam!fo" VALUE OF PROPOSED WORK $ 2-02 J 7 > r
SPRINKLERED BUILDING? 0 YES Np FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES NO
WATER SERVICE PROVIDER AKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER AKEHAVEN 0 HIGHLINE
0 PRIVATE(SEPTIC)
• • .....
t
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ. FT. SQ. FT.
BASEMENT
FIRST -z-SC) 3z 5-0
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT 0
EXISTINGPROPOSED TOTAL r`4" . :q 9R Y.{t" i ..•€ey 9jY Ejira '+F. ; i t Kz 3 <;-,'-
Si t s� '.
NUMBER OF FLOORS WA-- •e AJS‘.. N , T .,,T; t,,v1,, a�,, , .,
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING 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.
UnlGed- T (. a
MECHANICAL �-a (3��+ta95e� `
Value of Mechanical Work $ Coyh f LLI r
i
AIR HANDLING UNITS EVAPORATIVE Cee tAS 441, --- REFRIG.SYSTEMS
BBQS FANS A II ire IS(c 1 rc q WOODSTOVES I
BOILERS FIREPLACF.INSE• - TM RANGES MISC(Describe) Ii
COMPRESSORS FURNA E , GAS WATER HEATERS
DUCTS GAS PIP I •Do;
PLUMBING I .z.---
1 1
BATHTUBS(or Tun/sno e •,•.• •'OWERS WATER CLOSETS(Niko MISC(Describe)
DISHWASHERS iii-.` SINKS DRINKING FOUNTAINS 1
GAS PIPE OUTLETS �'' SUMPS RAINWATER SYST
7
WASHING MACHINES C/ URINALS HOSE BIBBS 1
LAVS(Bathroom Bir,. 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 e city, including its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE / INV /2 C bl✓i i� DATE 65. 0 2• o
(Signature) (Title)
RELATIONSHIP TO PROJECT c Owner 0 Agent 0 Contractor�Architect 0 Other
,l.t ..x -, , . ..: ^"',.�+ ' 1! -:� L•.'f v.. '
,t ` . Z
`
3 t a Lgi e 21 - 1 � -moi! " mgr� 6 ,, tet
'''
'•
e
*jj #7SS . �fit F!� ii�ia„�zdssw, ` � t :Z�,aNI � l�tL' Jfi .�u� f_t� �i ?�az it s*ul`
! �t iy-e_§�.� �w2sR13u � waa ; Y 2{La 16.x Mwf . t4A �� r " n ^jAmo " iKs
fiiii9� 9� asADtc � i6 bELEr — ttAtTTIEI ��� ?��xLI
p ix .- I sS( f ,:MWt4" i.:7AX� l ® kl�OeRWl �D [ mNuETA �.711,T_
n.,11.44,,(iron_To,,,,oen/1 1nn1 PaoP? ,fd. k\Hanciniitc\Permit Annlication