06-100953 ••
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CITY OF Wa RECEIVE-
i . f0(�7
Way PERMIT
COMMUNITY DEVELOPMENT SERVICES SF M' CO E EL PL DE EN FP
33325 8TxFEDERAL AVENUE SOUWATH98063-9.PO BOX718
r 9718 \R 0 1 APPLICATION B
7Y,
253-835-26007•FAX 253-835-2609
/ /
wiv"'c jnfederahnw.rnm CITY OF FEDERAL WAY
The following is requirr'4k, kti i an incom•lete a••lication will not be acce•ted. Please •rint le•i61 n in or type.
• PROPERTY INFORMATION
SITE ADDRESS 6 Sa 5• 3 3 CA . -1 E.i SUITE/UNIT# C
ASSESSOR'S TAX/PARCEL# . / ! 313? - C• O ZU_ LOT SIZE(sfl I ec (i 4.5+
LEGAL DESCRIPTION (e.g. Arnie Estates,Lot 1) 4-oT 2 of W . 1.- C/9Ptet)5 OFF CX- I04 IC., 1 Vi.5/0A-> I
(Attach separate page far lengthy legal description)
. ■ PROJECT INFORMATION
TYPE OF PERMIT ,UILDING 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 only)
CV "5"7-6 .771-1g-(-C-� ) '3/61) Sr-- Cos • (o21$4.• 60 LIP)
PROJECT NAME(Name of Business or Owner Last Name) C-11,14P,--)5 Po/i.JTk-• ef&F1✓5-5(cvv/3C. AC,C
,. ., .. • PEOPLE INFORMATION .
PROPERTY NAME PRIMARY PHONE
OWNER s 60Y5' X} me--T� SI Itni- ( ) 775- -C65t,
MAILING ADDRESS CITY,STATE,ZIP
1(.94( 91\-, A-,‘c p-v.t4o,Ua05, wrt cie 02 a
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
R-- ( /s33-CC e. ('--3)7-"L 2_ - 3 ''
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
) \i L A\J NW R_/7f LLup WA ( ) -
CITY OF FEDERAL WAY BtiSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
-B L / / ( )CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
Acc ,ECLIF3Nn / /
1 APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
E 1 0-0\f LIA-M0 ,45t±Ir(.T JVZ/C--)A-fa-r-_ 640 VL-A, (453)31-x- - 7s41•z
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
6706 ME i✓2W ) -. C 4-60-) 1-41G-r-0^-3
, ws- , t.. "-5s 1. ( ) -
RE TIONSHIP TO PROJECT FAX NUMBER
Architect 0 Tenant 0 Agent 0 Other(Describe) ( ) -
CONTACT NAME PRIMARY PHONE E- IL ADDRESS
M I(--IjfPS L. 1-4 6'(Lptrv)O (2153) 311 - -42.5 4 Z 6q qv c.L,4
LENDER 0,404q4(9•7a( 4C e 'r£a3 RIt i ,e=fit ' NAME CoNtCfl5r•NST-
i ��ti tt r : . =' OCA,ie-x_
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
t «, iii.i`1DETAILED BUILDING INFORMATION
EXISTING USE v n-37- 5
PROPOSED USE OffIC -(5)z
EXISTING ASSESSED/APPRAISED VALUE $ / L. VALUE OF PROPOSED WORK $ �> t 25�
SPRINKLERED BUILDING? ❑ YES XN0 FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES XNO
WATER SERVICE PROVIDER LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
• •
9
PROJECT FLOOR AREAS '
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ. FT. SQ.FT.
BASEMENT
FIRST 37_—)
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT 0
=sums PROPOSED TOTAL " k; .�a`� -
NUMBER OF FLOORS p loniP__. otic'
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
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 S t,-'y p ('`t(7
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(comm,raan WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS i,rTub/Shower comh,f SHOWERS WATER CLOSETS iraaeq MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS IOarbroomsinks( 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 the city, including its o cer�d employees,upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE g `U L DATE 0/ 2"
(Signature) (Title)
RELATIONSHIP TO PROJECT U Owner ❑ Agent 0 Contractor 0 Architect ❑ Other
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$0:4140004t4,04019,40
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