07-101952 RECEIVED.
CITY OF .° R 1 2 2007
Federal Way O 1 PERMIT
COMMUNITYDEVELOPN NTSERVICffi=ACRAL WP
. SF MF CO ME EL PL DE EN ~P
33325 8T't AVENUE,WA 9•PQ BOX 971 Gam' APPLICATION TD
FEDERAL WAY,FAX
98a35-260 1®DEPT. / / -
253-835-2607•FAX 253-835-2G09
uunn.cituoflederalwau.corn E.
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
l� � • PROPERTY INFORMATION �
SITE ADDRESS_ 3)7 8j i T" Gn cha n tet
( )Lt,u(j JC. t1 W 1-
SUITE/UNIT# 3 '
ASSESSOR'S TAX/PARCEL# I eI �
) 2 - ()1 1 0 LOT SIZE(sj)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) I ►ie_, (h, cita 2/ Pt3 Q.'
(Attach separate page for lengthy legal description) <J
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL ❑ ENGINEERING IAFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit on/u)_L_ _
Y)Et cLut,Cf_:t7 -
c r1 1, L
( t 1 0...r-r-5(i —
5( k_. ,cc I/ .
' .J ovi h re.
1 Lpp re--i cs-v-1 f ST>t-p ryi
PROJECT NAME(Name of Business or Owner Last Name) --he, 2.00 E 1Pa4)tc. A PI 33C
IN PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER C)eLi 6 1 v W 4 ( ) -
MAILING ADDRES CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
2:-r flood and j)u c i- SeYV Kr lstevr alfekierier (Dec) 1-a(n -(r124-(')
MAILING ACDDRESS �^-��,y� CITY,STATE,ZIP,, l ,y�C CELL PHONE
CiTY(j)OF0FE)DERAL B BUSINESS LICENSE NUMBER 8 Pa ttF- o._,ATI t_ DATE 8I FAX NUMBER
VI 98 10 -- 9 1 -60 - 6 t- (0-0(o) - 0-q-
corY at cora requires CONTRACTOR'S REGISTRATIONNUMBER EXPIRATION DATE ' E-MAIL ADDRESS
with each application I ) 0-nt 00 D JL- 0 A e (2L I(V( / 04
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
ler t-}ccct oxrl Duct Sery (3vto) 3-at.o -Cce-t-
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
t OC i c p.)-1-e, i�P Zl1 4...K=Pr aleAOP: ( ) -
RELATIONSHIP TO PROJECT l FAX NUMBER
0 Architect 0 Tenant 0 Agent littpther CpnTrrac_to r ( ) -
PROJECT NAME PRIMARY �
PHONE� E-MAIL ADDRESS
CONTACT (vte%l rY)1C�')eytPY (clue-)-) - p - 09)-E0
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 2 1 (aS. 39
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?irirES
0 NO
.6WATER SERVICE PROVIDER LAKEHAVEN 0 HIGHLINE n TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 1'l LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
r #
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑ /
NUMBER OF FLOORS EMOTINGegpn poscD TarTOTAL r�rorGSF TOTAL PROPOSED SP Tonu.SF
1:7
\
"NEW HOMES ONLY" NUMBER OF BE ROOMS ESTIMATEDELLING PRICE $
Indicate number of each type offixture to installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL ,
Value of Mechanical Work$ Di I , V COPY OF BID ESTIMATE MUST BE INCLUDED WITH APPLICATION))
AIR HANDLING UNITS ORA COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS F GAS WATER HEATERS X MISC(Describe)
BOILERS FI 'LACE INSERTS HOODS(Commercial) hire SuppreSSIon
COMPRESSORS ' RN} ES RANGES t f St• W'\
DUCTS GAS LO&,SETS REFRIG.SYSTEMS J
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST`,.' VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERSN
WATER CLOSETS IFoueq
ELECTRIC WATER HE TERS SINKS \ WASHING MACHINES
HOSE BIBBS SUMPS
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 application. I,
NAME/TITLE / /�i� /A",..4/_/..t...-1..._ DATE /(l
6/ego O
( , .t e) (Title)
RELATIONSHIP TO PROJECT 0 Owner ❑Agent tkontractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
❑NEW ❑ADDITION n ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION CHANGE OF USE? ❑YES o NO
NEW ADDRESS REQUIRED? n YES o NO UP/SEPA/SU? ❑YES o NO
PLATTED LOT? u YES ❑NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100-April 2,2007 Page 2 of 4 k\Handouts\Permit Application