05-103347 ..„
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Federal Way PERMIT JUL
1 2 ZO
COMMUNITY DEVELOPMENT SERVICES
SF MF CO ME EL PL DE EI�FP�•
33325 D AVENUE WAY,SOUTH•PO 971 9718 A P P L I C A TFQ TD / / \
FEDERAL WA 98063-9718
253-835-2607•FAX 253-835-2609 <<Q( DFRAC 1N
www.aalorleaeraiwau.comAV
The ollowin. is re,wired in ormation-an into .tete a•.lication will not be acce•ted. Please •rint le.ib in • or j'
• PROPERTY INFORMATION
SITE ADDRESS 64100 (o AO ES SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 9 2 lO 4 $ 0 , 0 0 1 0 LOT SIZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) 6 pr�fiA•Ci1-lE0
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING ❑ MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING A FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
F--1iZ.E SPiZii 1KL�2 -1.1 S
PROJECT NAME(Name of Business or Owner Last Name) F C'E AL WA,/ AMEuL.ATOeX'i 501261 1ZY 6ektree 15
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER F`n1 A5C_ LLC ( ) -
MAILING ADDRESS CITY,STATE,ZIP
P.o. 5e,x &10 -e-"LAc%K. -PIN-loop, WA '1)010
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
lac. Fi ?CzoT(=10i.l 6,6,)1rti CaR& r1DFceil (4Z5)432 -4401
MAILING ADDRESS :#I 50 CITY,STATE,ZIP CELL PHONE
2220 HARE V/A-U.G�1 1-11,31 5E HARE VAI CEE/, LOA 18038 (10(o) " 41 - )LC4
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
Z C - C 3 - ( c i 41 13 s -B L (Z/ 3i /C (41Zij2)4-3Z -01't4
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
Ac E i P s 1 4Z P 1 / /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
SAt-iE AS 1 epo ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent It Other(Describe) 6012=4---6LtTI?AC-"iZ-'�. ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
6. 2f-i_•-1 t-1OFFEti (4L6) 413Z - 4401 ymoff-eteacefire.net
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 11 A t.f
'
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
g7y5535
I •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ. FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE LI CARPORT❑
EXISTING PROPOSED TOTAL TOTAL EXISTIED SF TOTAL PROPOSED SF TOTAL SF
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.
MECHANICAL
Value of Mechanical Work $
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 Mb/Shower Combo) SHOWERS WATER CLOSETS(mart) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks) 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 officers and employees, upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE .._ DATE 7`I Z
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner 0 Agent )it„Contractor 0 Architect 0 Other
FOR OFFICE USE ONLY
❑NEW ❑ADDITION ❑ALTERATION o REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? o YES ❑NO UP/SEPA/SU? ❑YES 0 NO
PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100—August 19,2004 Page 2 of 4 k\Handouts\Permit Application