07-103208 RECE►VES
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Federal way PERMIT — —
COMMUNITY DEVELOPMENT SERVICE�UN 12 2007 SF MF CO ME EL PL DE EIV
33325 8''"AVENUE SOUTH•PO BOX 9718
2F5E3D-8E3RA5-2607•FAXWA 2593-8633591618 1 Y OF FEDER yP LI C AT I O Ni1> /
www.ciluoffederaluxtu.com BUILDING DEPT, 1
The ollowin c is re.wired in ormation-an incom c lete a s a lication will not be acce a ted. Please .rint legibl (in ink)or ty se.
J /' yy��/ , // • PROPERTY INFORMATION
I /� ( VOA SITE ADDRESS /� 4447 '(/(��V `f lA L l• ( (l1 Cx&1 VVI/J ( V V A SUITE/UNIT #
ASSESSOR'S TAX/PARCEL# _47 3 2 2 0 ""T - q 0 � /v LOT SIZE (sf7 iL / �t_11
LEGAL DESCRIPTION (e.g.Acme Estates, Lot 1)
(Attach separate page for length))legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING LeJ FIRE PREVENTION SYSTEM
PROJEC DESCRIPTION-(Pro '•e detailed description o work included on this permit only)
Yl \OVVI lC -vA 0 UV\UT . • ") i (1 `- ri MAtSi0Ci
0
PROJECT NAME (Name of Business or Owner Last Name) La, 'i' I I l k i'S � U U/ 1 A f , Lt .-
• PEOPLE INFORMATION
PROPERTYE•/� ('(�, WOK}J� �/ PRIMARY PHONE
OWNER AmS' l Oldv' 11 V`�P�1 I ��e ( ) -
MAILII(�(NG(Y.LIffY ADDRESS VA b\VI , c ( v1Pi 98055
CONTRACTOROMPANY NAME APPLICANT NAME OFFICE PHONE
\rdier ( d1 ,Tao_ ( ) )-2
MAILING ADDRES� o. 2 r,` -1 R4 CITY.v �-TATE.ZI1 I� ^ Be z CELL PHONE-- -
\CITY"OF FEDERAL WAY BUSINESS/LIICCEE"yNSSE NUMBER 7EXPIRATIO(N�DATE FAX NUMIBER
10—-at - 1 L L q. ( B L \L / .221 /C 4.. ( ?3 )(�''1Z -7277
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
fr4bL2
Dy / �i / /
APPLICANT QOMPANY
TvIv(r NAME WA-ion PLICANI NAME OFFICE PH/OyN`E� �/
G�DY( � i RESS CITY.STA- -f-- (7 2) 1 2- -1-z1z.
V HIP OP D .
10(01'v+, `CL-/j - j 2 FAXNUMBER -9.RELATIONSVV
❑ Architect 0 Tenant 0 Agent Other(Describe) C!VVI•k (�J.?2) 8-i-7 -i?j1
CONTACT (
NAM .3c04 PRIMARY PHONE E-MAIL ADDRE S
556 19-ef- ,tket-Cofl 1—
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY.STATE.ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE ['r
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ e�!J j 418 I
SPRINKLERED BUILDING? r'YES E NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? Li YES 0 NO
WATER SERVICE PROVIDER CAAKEHAVEN r HIGHLINE TACOMA S] PRIVATE (WELL)
SEWER SERVICE PROVIDER o LAKEHAVEN 0 HIGHLINE PRIVATE (SEPTIC)
* • •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED I TOTAL
BASEMENT - SQ. FT. SQ. FT. SQ. FT.
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF a OTAL PROPOSED SF TOTAL SF
**NEW HOMES ONLY** NUMBER OF BEDROOM ESTIMATED SELLING PRICE S
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 EVAP•-.:TIVE COOLERS GAS LOGS j REFRIG.SYSTEMS
BBQS FANS HO (commereian WOODSTOVES
BOILERS FIREPLACE IN . --- RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
/-
PLUMBING /- /
BATHTUBS(orThb/Shower combo) S.•VERS WATER CLOSETS trouet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BI\BBS,
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. JJ
NAME/TITLE c51 tot-rU iZ DATE 4; ` V r c 1
(Signa 7.--) (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent $Contractor 0 Architect 0 Other
FOR OFFICE USE ONLY
❑ NEW o ADDITION LI ALTERATION c REPAIR c TENANT IMPROVEMENT
BUILDING SHELL ONLY? 0 YES o NO BASIC PLAN? o YES 0 NO
ZONING DESIGNATION CHANGE OF USE? -YES n NO
NEW ADDRESS REQUIRED? c YES ❑NO UP/SEPA/SU? o YES ❑NO
PLATTED LOT? o YES n NO DEMO PERMIT REQUIRED? n YES n NO
Bulletin#100-January 1,2006 Page 2 of 4 k\Handouts\Permit Application