04-103244 BEC1JVED
COMMUNITY DEVELOPMENT SERVICES
33530 FIRST WAY SOUTH•PO BOX 9718
cmr OfAUG 4 FEDERAL WAY,WA 98063-9718
Federal Way ` MIT APPLICATION 2536614I15•FAX: lwagco-1129
ruww.dr4n/jedeml wa4.corn
For Office Use Only-
FW File IM15111-N.�UI15DINC: :: I 6 3 - 5 1 TD:
The oliowin• is re.wired in ormation-an incont.fete a.•lication will not be acce.ted. Please .rint le.ibl (in ink)or .c.
/'. PROPERTY D ORMATION
SITE ADDRESS: 2'4: ( '7 s�III- ' -ST, SUITE/APT #
Q1
ASSESSOR'S TAX/PARCEL#: - SQUARE FOOTAGE OF LOT: ) 3c{CC S4," t----r, 10
LEGAL DESCRIPTION (e.g.:Acme Estates,Lot 1) T L LM-(6, kc T Li V
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT(This application): UILDING PLUMBING ❑ MECHANICAL 0 DEMOLITION
0 ELECTRICAL 0 ENGINEERING❑ FIRE PREVENTION SYSTEM
/
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only):_2 J/9/" "/
;V . SCJ 4_,J
k;6_/---77.
PROJECT NAME(Name of Business/Owner Last Name): /yj.
. . -• PEOPLE INFORMATION
PROPERTY NAME: PRIMARY PHONNE:
W
OWNER 1l.J1lV VY\ �l \ AJ . (G��) Q_7/ -60oS
MAILING ADD S(STREET ADRESS;): CITY,STATE,ZIP
2.411 3cTD <ST F6 (10.1 (AM . 9E06-3
CONTRACTOR NAME COMPANY OFFICE PHONE:
RotJW17 &) i Cr(FIC kb S fl � T.Ruc-�loll ',E (2c' )54,2 -4.2((et WO,
MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP CELL PHONE:
\ (253) - 7 (33
i /l 1 CITY FEpEW9Y BJJ$INE`�S,SY•IE�N�SE UMBER:` ,^�� �FJ(pIRAT10N DATE: _. I �AX NUMBER: -
t/ ^rGrKLL'333'--- I /Oeil — (/A (/ UDl1 (,/�(JlJf�) (/,✓�lJ) J�[I%/ )`—CQI{TRACI'OR5 REGISTRATION NUMBER: `'� yr EXPIRATIONADATE:
(c�(IW/•/off card required with each application) 61C. V t S S T 9, 3 ' i / l io
LENDER NAME: DAYTIME PHONE:
(If Proposed Value>$5,0000) N/14‘/14‘ _ ( )
MAIUNG ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP
APPLICANT: e COMPANY OFFICE PHONE:
ACD hl(crC(-)0 i th ST,.14-0))CE ( )b-702-4-q19614
MAILING ADDRS(STREET ADDRESS): ITY,STATE,ZIP EVSM44+Q4HONE.‘6./..(.....
2°x°42 et402C-4 ) 't6 IQ- um 2, IAA •° 3`Ta (z63) qea- 7133
RELATIONSHIP TO PROJECT: " ��..�,p�..,- n FAX NUMBER:
0 Architect 0 Tenant Other(Describer . CiIU f 2r 1..,t j - ( ) -
CONTACT PERSON FOR THIS PROJECT: ❑ Property Owner ❑ Contractor Gi/Applicant E-MAIL ADDRESS:
■ DETAILED BUILDING INFORMATION .
EXISTING USE: ' SKI /1/4-)Cy PROPOSED USE: 1,i ?G\6.//
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $ 2 /5SO G
C
K/
SPRINKLERED BUILDING? CI YES /NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: 0 YES Leg()
WATER SERVICE PROVIDER #f LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER Q'LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
• • PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING S•. FT. PRO D SQ. FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
L
GARAGE/ 1 0 X17 2 SQ FT
67 'W F
HOW MANY FLOORS? TOTAL EXISTING TOTAL PROROAR exarlNG AND ROPOSED
''''ra.giaZ Ao PT Z80 FT, 2-
"NEW HOMES ONLY NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■
. FIXTURES •
Indicate number of each type of fixture that is to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
i
- AIR HANDLING UNITS EVAPORATIVE C L RS GAS •= . • REFRIG.SYSTEMS
BBQS FANS ••DS( _= WOODSTOVES
BOILERS FIREPLACE INSE RANGES MISC(Describe)
-
COMPRESSORS FURNACES GAS WATER HEATERS
- UCTS GAS PIPE:0000.....
PLUMBING
ATHTUBS or Tub/Shower Combo) SHOWERS AVER CLOSETS(rout) MISC(Describe)
DISHWASHERS SINKS AB& :`:,'RINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS
FIM ry -' NWATER SYS
WASHING MACHI. URINALS HOSE BIBBS
LAVS)eathroom VACUUM BREAKERSELECTRIC 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 a • defense of such claim), which may be made by any person, including the
undersigned, and filed-agafns e e City of i eral y, but only where such claim arises out of the reliance of the city,
including its officers and ee •s, •• p'he a acy of the information supplied to the city as a part of this application.NAME/TITLE: , ^• 'j 7 DATE: -7 - 2 7 • Cli
(Signature) b (Title)
RELATIONS • TO PROJECT: 0 Property Owner 0 Applicant pit ontractor 0 Architect ❑
FOR OFFICE USE ONLY:
a NEW a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a YES a NO
ZONING DESIGNATION: - CHANGE OF USE? ❑YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? o YES a NO
PLATTED LOT? ❑YES a NO DEMO PERMIT REQUIRED? a YES a NO
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