07-101515 ir:
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CITY OF
Federal Way oF DEs E RM IT
COMMUNITY DEVELOPMENT SERVICES�';� O NG OE SF MF CO ME EL PL DE ENO
33325 D RALAVENUESOATN•PoBOX 9718 1�' APPLICATION
FEDERAL WAY,WA 98063-9778 D / /
253-835-2607•FAX 253-835-2609
www.cituonederalwali.com
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION/FO /
SITE ADDRESS V? l i 7 `tc / W j S, / r `7,ee 2 / /^l�u!�/ SUITE/UNIT# /'
ASSESSOR'S TAX/PARCEL# 5 3 a O. V- 9 v 6 e, LOT SIZE(sf) `-- 2 A✓C
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
G, P1, [(file - 679 yr
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING 0 MECHANICAL
❑ DEMOLITION 0 ELECTRICAL 0 ENGINEERING AFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
/ t-, ( ' �ir//.--c izaW, ,--_-,,,,k- i v/ ' v fid Si-
, . S frI,1 Pete.— StiS{-err!
PROJECT NAME(Name of Business or Owner Last Name) 6/ /7, / .. •C.SS / ,• 'A/ Ai 4// /'f f ti 7"
• PEOPLE INFORMATION
PROPERTY NAMEPRIMARY PHONE
OWNER (1-51,14-0,. i/C v-e tvome/r I 6'4' "An ( /2c) ?(n y - a 6.7
MAAIILING ADDRESS I� c� CITY,STATE,ZIP ,d E-MAIL ADDRESS t
1 CO( 1M.0."S K 0 Si-& j S ' ae✓h,-,/ ti,if v�S 7 t/G;1/f'QCl,�1 7++n(ter.C OWH
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
A{Che c Can SVLA.hi), (Do „ly ZS3) 87z -?Z 2?
MAILING ADDRESS CITY,STA .ZIP CELL PHONE
2 - S, Zorn sr Ek-/I}, ct49 9£03'2 (.2c62 ) ?3/ - ys37
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
2-6 -" b n I 04423 —(Vo—8(-- /213/ /07 (zc3) S72 - 7277
corn of cera requires
CONTRACTOR'S REGISSTTRATION NUMBER' EXPIRATION/� DATE E-MAIL ADDRESS.
with each application //_-11�`l/_)s L'1't C Jam' " )Vii j 41,/°) vetrZ{tt' �2^1144--A.2"1. (N.M
APPLICANT COMPANYyAmE APPLICANT NAME OFFICE PHONE
/�flT'rci/4� C) T ( )
ES -
MAILING ADh S CITY.STATE,ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑Tenant KAgent 0 Other ( ) -
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT ) C-ylr('n (2S3) e72 - ?z-z.Z ch,....J��CI,L�/(- c/4 6.,„,
LENDER NAME J Per RCW 19.27.095: 1
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE.ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE Iasi‘'4:-- / )'te Li (Ur S4.11-4/1-is')r' PROPOSED USE (()i44124<'"-C-t.,,/ Ai
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ /Sj & 'o
SPRINKLERED BUILDING? 'YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? (YES 0 NO
WATER SERVICE PROVIDER LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER /&.LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
• •
■ PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
6Q,FT. S .FT. S .FT.
BASEMENT ' 1
F11ZST 406 y Dict-o
SECOND 34 Sly 3,atrc!
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(D COVERED OR ❑UNCOVERED?)
GARAGE 0 CARPORT 0
LIISTDIC PROPOSE TOTA4 TOTAL EELSE,RG ST TOTAL PRI7OOAD Sr TOTAL SF
NUMBER OF FLOORS a y$,at $j 4.6.0
"NEWIIOMES ONLY'"' NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
■ FIXTURES
Indicate number of each type ofJirture to be installed or relocated as part of this project Do not incll,dP existing fixtures to remain.
MECHANICAL
Volu"of Mechanical Work $ _ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(commeroAu
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS for St/Shaver Combo) VS IBlem,00m 5tnk, URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS 4q WArei. Ptr'rtgte 1*4ZLS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(moa) ` DIZAcm ti
ELECTRIC WATER}(EATERS SINKS WASHING MACHINES 7__.I
HOSE BIBBS _ SUMPS 5 40 ?oak— -Vva•Kvi S l.
SIGNATURE
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 applica
NAME/TITLE W e ___________________DATE I t)O 7
(nue) !11
RELATIONSHIP TO P•OJECT S Owner ❑Agent ❑ Contractor C Architect LI Other
❑NEW ❑ADDITION ❑ALTERATION o REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES a NO BASIC PLAN? a YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? ❑YES n NO UP/SEPA/SU? a YES ❑NO
PLATTED LOT? n YES a NO DEMO PERMIT REQUIRED? u YES n NO
Bulletin#100—January 1,2007 Page 2 of 4 k\Handouts\Permit Application