05-101836 ---`rem- al •Way PERMIT 0 F CO ME EL PL DE EN FP
COMMUNITY DEVELOPMENT'SERVICES
333258^tAVENUESOUTH 9•PBOX 9718 APPLICATION TD
FEDERAL WAY,WA 980633-9718 J
253-835-2607•FAX 253-835-2609 /
www.ol uo((ederalwo y.tom
The ollowi • is re. fired in ormation-an Inco .lete a..lication will not be acce.ted. Please •rint le.ibl (in i or .
�1■ PROPERTY INFORMATION
SITE ADDRESS 230 I S S. 3047-'4' ST. SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# `S 3 7 0 0 - 0 1 3 5_ LOT SIZE(sJ (S VZo
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal descripnon)
. • '■ PROJECT INFORMATION
TYPE OF PERMIT CWBUILDING IW PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
30`x 24 c2 Th' acri P- 1.4 - col j z . STo ST-0- 464, .
1- 1JT Q
PROJECT NAME(Name of Business or Owner Last Name) 1.0(Q....101,e..7._.
• PEOPLE INFORMATION -
PROPERTY NAME PRIMARY PHONE
OWNER -RoZre-r 4'-1‘c-- -RA /JI 2_ (Zs-3 )Qz}(p -082.G
MAILING ADDRESS CITY,STATE,ZIP
2 ao 1 S. 3Og..-rt4-3-1/2... FC (ari L woui ) km. a�oo3
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
►ra eons-r-cuc T(01.1 Cray(G4 7<J l\tlUatoc 5 (2S3 ) et9z- -SIR
-7MA,I�LIING�ADDRR�-E(SS '�^'(�' CITY,STATE,ZIP,C ) Q`$�� CELL PHONE
494, C D�-riu2rAl�KoERAL WAY ES6CENSE NUMBER r 3 rEXE' ON I q 0 (F )ass - 13 3
CITY OF B L.
/ / ( )
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each applications EXPIRATION DATE
/ /
APPLICANT COMPANY NAMECAPPLICANT NAME OFFICE PHONE
A -a� —k0 V �2v[GL .).0 K-Ito m S (Ls-3)6C�Z 4q i
MAILI A D S I TY,STATE,ZIP - CELL PHONE
Zo&42. uiX(&I �'IG- r.AKC-,14•c�3g0- (z •3) `tee -1(33
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑ Tenant ❑Agent ❑ Other(Describe) .apL) t OR ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
t2oki MvJ-joLIS (es" ) q88 - 1 ( 33
LENDER ...,---,,,--•,-,•,••••.o r" tMt. 9V7,095: ,`,1" -c,i. ,x NAME
. b` uued f proJectYvalue exnderilformatiorn
, eds . , tv i
r4MAILING ADDRESS CITATE,ZIP
. •. ■ •DETAILED BUILDING INFORMATION �l . •
•
EXISTING US —_=-;?_- -_r _ -11.7, - NIte ,_, 1r. -; [j.'ROPOSED USE Mac) Ck46 4 19os:?FT•
Y'S/a770
cc/EXISTING ASSESSED/APPRAISED VALUE $ ''`Z-:"------ .• � '7 S/VALUE OF PROPOSED WORK $ o?7U
SPRINKLERED BUILDING? ❑ YES e'NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES t i'RO
WATER SERVICE PROVIDER 'LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER GYLAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
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