06-100983 RECEiv
•
CITY OF MAR 022001 �� oso ? 3
Federal Way PERMIT
COMMUNITIDEVELOPMENT SERVICES IY OF FEDERAL V SF M r CO E EL PL DE EN FP
33353-83ALWAEFAX 53_SOUTH•Po�o9718 BUILDING kfPLI CATI O N
FEDERAL WAY,FAX
53-8 3-260 D (ti....x___/
www.cilyo(/edemhuny.aom
The following is required information-an into •lete ap•lication will not be accepted. Please •rint le•ibly in in or type.
■ P,.ROPERTY INFORMATION
SITE ADDRESS ( ' �O �a aTi4 3 3'dJJSk} SUITE/UNIT#
q
ASSESSOR'S TAX/PARCEL# ( 2 6 0Q . ("02 a - _ _ LOT SIZE(sfl 1 Tit 4 5 1
LEGAL DESCRIPTION(e.g. Arme Estates,Lot 1) 1.--057- 'L- aF- .,,x. -i c A 2cis or-f tc.g. P(A- iC of 115,trj 1
(Attach separate page for lengthy legal description)
•,•; , -.:•> .■ PROJECT INFORMATION ,
f3ELC.
TYPE OF PERMIT CUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this^3r Lit only)
ONE- t`�TLL 2 oo s .
inPROJECT NAME(Name of Business or Owner Last Name) Cl'�f�tPO5 '1 a I NM_ ?r_c 55(OR AL �,1)
... ,....,,.:� PEOPLE INFOi2MAT •
PROPERTY NAMEG PRIMARY PHONE
v,�
OWNER :- �.ru.i(Z .51 sc, 4 .i--L C (4,c-) 72,,- -6 -6-2.
MAILING ADDRESS CITY,STATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
.1?›PC--I /ACC-P (Z._57) .? -3351
/u i0> MAILING ADDRESS y{ CITY,STATE,ZIP CELL PHONE
I y'(41.1-
_
P' CITY OF1FEDERAL WAY BUSINESS LICENSE NU BER PJ �`�u rEXPIRAATION DATE �AX NUMBER
t - - -B L / / ( )
CONTRACTOR'S REGISTRATION NUMBER)copy of card required with each application) EXPIRATION DATE
Accf`?Ec-L. FE 3Nf / /
APPLICANT COMPANY NAME APPLICANT NAME
OFFICE PHONE
i'`t• 141Sart.,4440 N2c1i-tlet.3" M) crte-K.c._ "-}-c.v W-53) *4- -7,5(
MAILING ADDRESS � CITY,STATE,Zir CELL PHONE
7 C- --). M fe-12-1 SOI' - C7/av) C11C�?tso- /tiJ 2 03 S f-- ( )
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑ Tenant ❑Agent 0 Other(Describe) I ( ) -
CONTACT NAME PRIMARY PHONE E- AIL ADDRESS
L(I C.N-ISL. 140VLP 0 ( ) 34�-- ?S-1 t- 1. -1,.t
LENDER 3,43 r .01�„�d+ i itfi'Ys`psY l y ,. zI
NAME ,.g? -
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
'. • :,r, .! ".:.`,.i`t :r ',, fi.2 ',t II'.D+TAILED BUILDINGIN PRMATION ,:= t '
EXISTING USE IThC.Ai-J 1 PROPOSED USE off(C_e-(.S)
EXISTING ASSESSED/APPRAISED VALUE $ v u S 4 6 0 VALUE OF PROPOSED WORK $ 2 31.( -( 0.'
SPRINKLERED BUILDING? ❑ YES `)NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES , NO
WATER SERVICE PROVIDERAXEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) qq
SEWER SEF VICE PROVIDER KEHAVEN 0 HIGHLINE
0 PRIVATE(SEPTIC) 1 ,8„15-8-296 D
• •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ. FT. SQ.FT.
BASE.,/;ENT
FIRST o 2 orE)
L
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
ERISTIM0 PROPOSED TOTAL
NUMBER OF FLOORS '* ( �`
**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.
MECHAHICAL - C.-CIA pug J O /s w'It.T T. ),
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commercioi WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(orTub/shovorcombo) SHOWERS WATER CLOSE-IS iroaoq MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom sirilcs) 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 Wily 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 t city,including its officers a. -employees,upon the accuracy of the information supplied to the city as a part of
this application. � — ,
NAE/TITLE DATE
M
(Signature) — (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent 0 Contractor i. A chitect 0 Other
3 3 r Z ( 00.1" "'
J g����3y{sa".��.r - 3" r rt�"lu�� 1.fi��k�q•.R'Y i za�,1�,�Q� � c,�.� rh� �®,a�_'h-^"���4���LL�yk'�3��h�..;�ay,,'�#.��,-'.
,nn _ �nnc Arra)nfrl k\Handnntc\Permit Annlicatinn