06-100951 •
L (e) - to 9 5-1_
CITY OF 0 4EC6rIV9�4
Federal Way PERMIT
COMMUNITY DEVELOPMENT SERVICES SF MF CO I E EL PL DE EN FP
33325 8rff AVENUE SOUTH•PO BOX 9718
FEDERAL WAY,WA 98063-9718 MAR OA p p L I C A T I O N TD / /
253-835-2607•FAX 253-835.2609
www ciiya(fedemlwnti.tern CITYWAYIIF FEDERAL WA
The following is re•uirer ifto igePrFptin inco .lete a••Iication will not be accepted. Please •rint legibi n in or type.
MI PROPERTY INFORMATION
SITE ADDRESS 1i/ avm So 11 11-1 .33` C.- -I SUITE/UNIT# 5
(2.565. 33(. q .--
ASSESSOR'S TAX/PARCEL# / 26 Foo' Cx)2 a - — LOT SIZE(sj7
LEGAL DESCRIPTION(e.g. Acme Estates,Lot 1) ..--(1,-1. 2 of Y`114.57- C/31,4/k 5 OFftc,C f-lcligiC I i is.ie i oA.) 9
(Attach separate page for lengthy legal desoiption)
` �'PROJECT INFORMATION
TYPE OF PERMIT BUILDING 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 onl11)
c!'N� 51Zcl 51*LL. I 3?5v -5.r•. C - -' ' oo c ')
PROJECT NAME(Name of Business or Owner Last Name) cAt-teus )moo I I )'r-o fE-SS IoNHL eAg t`
•
PROPERTY NAME PRIMARY PHONE
OWNER Soo I-+ Thig<E_ 7})1t?3i �1CT1 l.- -L ( 11-5-) 775 - 65'l
MAILING ADDRESS I CITY,STATE,ZIP
(
(Di\ 911- mg-. /\ . £-iM o n)d 5, WA o020
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
fC-I/ -tr (a22.) 33 -.,
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
&o( vAtucy /3v6- w g1-v1,-L.LuP �,v ,- �3-7-+- ( ) _
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
-B L / / ( ) -
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
.ALc_fLK cc,q-73N( / /
—
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
1-4• )4-1AIL.AA)t9, ,&1?ci4 IT-C.cT N iet4 L.. aiovU+wto (25.;) 3149- --}54�
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
q(''( tNif-(0IAu IE- C4-°s) 14/L7aN ,wr} /g 5'1 ( . c3) -'44- = 75-42
RELATIONSHIP TO PROJECT FAX NUMBER
,Architect ❑ Tenant 0 Agent 0 Other(Describe) ( ) _
CONTACT NAME PRIMARY PHONE E-I¢AIL ADDRESS
M)C11''£C-- 14C5VILA0J0 (Z53) 1"q'- 75i1_, VI 0V t^i Yct. ±
LENDER • l -;,14-; 1a6 l ' a `zix' t*" NAME C CO-MC/a. T.
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
, ' ■'DETAILED BUILDING.INFORMATION
EXISTING USE V -' - PROPOSED USE off'ce CS,)
EXISTING ASSESSED/APPRAISED VALUE $ CC' 14 a`7 VALUE OF PROPOSED WORK $ j"LG..I -5-b
SPRINKLERED BUILDING? 0 YES (>010 FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES )•lO
WATER SERVICE PROVIDERLAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
•
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ. FT. SQ.FT.
BASEMENT
FIRST N/As Sq, 3']So
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE D CARPORT El
mamma
OF FLOORS amma PROPOSED TOTAL
OT ; +( l r m~ � - n
**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 �(--_ O K1t_ - i 5 1 y4 TT--
Value of Mechanical Work $ 1
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(Commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or rub/Shower Combo) SHOWERS WATER CLOSETS Qoii MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Blairs( VACUUM BREAKERS ELECTRIC WATER HEATERS
y DISCLAIMIER/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,includ tag-the undersigned,and filed against the City of Federal Way,but only where such claim
arises out of the reliance of the • ,, including its •ficers and employees,upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE % /4` DATE 2• 2306
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner 0 Agent 0 Contractor Architect ❑ Other
as
1:4049'
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