06-100954 •
RECEIVECIRP I/
CITY OF )—
00 61 '57(
Federal Way 'R 0 1 2006 PERMIT
COMMUNITY DEVELOPMENTSERVICES SF M' O EEL PL DE EN FP
33325 8^t AVENUE SOUTH 980 O BOX 9718 8 �p P L I C A T I O N
FEDERAL WAY,WA 98063-971$ FEDERAL / /
I 253-835-2607•FAX 253-835-260 ILDING DEP
www.atgofedemlwau.rntn '
The following is required information-an inco •lete a••lication will not be acce•ted. Please •rint le•ibl in in or type.
�
MI PROPERTY INFORMATION
SITE ADDRESS 6 S a uni- 3 34"J t.• j f���j SUITE/UNIT# C)
ASSESSOR'S TAX/PARCEL# ( �lv-- bd- DOZ.o
—
LOT SIZE(4)
LEGAL DESCRIPTION(e.g.Arne Estates,Lot 1) LT .2 w - G9Y'tPJ S o rli PL L ,(pI eis,uN I
P (Attach separate page for Lengthy legal description)
• PROJECT INFORMATION. ---•---,,-.'t
TYPE OF PERMIT yf.BUILDING ❑ 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) 1
0 /J� S� -gY 5 LLQ 3'? c 5�. C 05- (c)2_ 18(.. crc r 1p)
PROJECT NAME(Name of Business or Owner Last Name) 6-114,MPO S ;P6 I NTS f3r a5 E is)/& ei4lf-(C_
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER 3 u Sl-�- Tb"P-£f. "rif1f T( XTP' Ll_.L (26j) 354 --741t
MAILING ADDRESS CITY,STATE,ZIP
l (011 9, • A vo_ N c4---A-1- Votesa Nb , q o2 b
CONTRACTOR COM,ANNY NAM APPLICANT NAME OFFICE PHONE
( 3-C� . 'E.-1E (''22_ ) 331'
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
G) v/ (.-.>`t Aii€ Ai 1s0 f`i .i-(.-uV, w& F8-371- ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
s��- - B L / / ( ) -
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
SCC-g CL q‘ 3Np / /
, APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
t„(. 14•6 64 NO i Aj2UUTci ?-t l Ud/ L 14.0v4-{IN✓J (15 ) 3i4- - X42
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
7
CZ) M ►O/f&J lE . Ceb6 i)) /4ICT-a1ui (-. 6- ?.‹83 5 f (2_53) j-4 -754L
RE�TIONSHIP TO PROJECT FAX NUMBER
�Ty�Alchitect 0 Tenant 0 Agent ❑ Other(Describe) ( ) -
CONTACT CC//NAME� PRIMARY PHONE MAIL ADDRESS
M16i C- 40VLi O (?.3) 3g`- -1sc C- c.)\(gv6_71 CP
LENDERi' + s. ,s.i=) v 4x { NAME G.ONtC13'5•n4,1'
t';-%Y t t r��{a,-� , /J I/\ (-)W7`)/ )-
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
> ,■ ;DETAILED BUILDING.INFORMATION . : ?' L
EXISTING USE Vit PROPOSED USE C lC-.SCS)
EXISTING ASSESSED/APPRAISED VALUE $ 6 z--,-5,4---- VALUE OF PROPOSED WORK $ 7-Z-4., 2 .1)
SPRINKLERED
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) _�
• •
i
PROJECT FLOOR AREAS •
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ. FT. SQ.FT. .
BASEMENT 1
FIRST
35� 3?
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
1
DECK(COVERED?)
GARAGE 0 CARPORT 0 j
=STING PROPOSLD _.:,, ->c ..r
NUMBER OF FLOORS N/II— OASA- crit
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ 1
• 1
i
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing factures to remain.
MECHANICAL 5 Pi- .k._. O/JL"1 mi 5 ?F?-,1ti I T
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(C.mmercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/ShowerCombo) SHOWERS WATER CLOSETS Iroa<q MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom sGJcs) VACUUM BREAKERS ELECTRIC WATER HEATERS
is ;: ' ;; 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 o / of f the city, including its ofrs and employees,upon the accuracy of the information suppliedtothecityas a part of
this application.
Ai
/ "4` ( d 2
DATE . w
S
NAME/TITLE
(Signature) Achitect
(Title)
RELATIONSHIP IO PROJECT 0 Owner 0 Agent 0 Contractor ❑ Other
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