07-100951 p RE *V •
f- 1 ; 22ODT / \/ A C
CITY OF O 1 — / U V / / /
Federal Way G` V
CITY or F grIA SF MF CO ME EL PL DEE FP
COMMUNITY DEVELOPMENT SERVICES BUILD IDEPT
3332E D R LPfH PO 9 9718 PpLI CATI ON
FEDERAL WAY.WA 98063-9718
7D
253-835-2607•FAX 253-835-2609 / /
w w w.c ituo ffede ral wau.com
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
VvT
t l�• PROPERTY/ INFORMATI�ON c�/
SITE ADDRESS 34817 1C-A4( -D 19A-a.`Cw(y"' J ' �`�- SUITE/UNIT#/� I d
ASSESSOR'S TAX/PARCEL# f U 5 21 5 - Of / e LOT SIZE(sj)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERINGFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onto)
{U STY!-U-.pt--R,AND O Pi-00i TV v--) ''('D a l5 rt.&I, F'iitsc IQ'CA2t i ,-IST
PROJECT NAME(Name of Business or Owner Last Name) IW L A Z A-
-
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE '
OWNER ON S 0 u) LLC- (y7 )cfS3 -4loo
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
9►S 118T`f- Ave, SE SA*303 ( oE. 1 WA- CODS-
CONTRACTOR COMPANY NAME ) APPLICANT NAME OFFICE PHONE
P ig.c, Kow f. Sect+u,9 i 1.C-. -rim 7-A44,J (2A6 )7$k -3(06
MAILRESS CITY,STATE,ZIP CELL PHONE
828 ADDRESS
Plie sv -Tbj'Tu'Tl < i,ic-
i %Ni
(y ) _
CnY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
2-0 -oz - OOS4 q 7 (206 ) 716 - $i(cA
COPY of card requiredCONTRACTOR'S REGISTRATION NUMBER EXPI1A1101I DATE E-MAIL ADDRESS
with each application Ll PRC//f5 c1-7 3 P N /6/3o/07 .6orre e_,FS. 6Z_
APPLICANT COMPANY NAME ea PAPPLICANT NAME OFFICE PHONE
`PACC n E k S€c..wTLTi s7n� d (7 040 78'8 -38'06
MAILING ADDRESS Y.STATE,ZIP CELL PHONE
8Z8' �OPI.ArL {>Lf C Sint CITStnne / 1.10 *Ng ( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑Tenant ❑Agent 0 Other COgr C-47:22 (Zo(, )72_6 - at(00
PROJECT NAME ,�" PRIMARY PHONE /E-MAILAAD�DR�ESSS
CONTACT -TlIA A-Tt.i(J (ZO(e ) 7$8 - 38043 -bare_PFS S ,32
LENDER NAME Per RCW 19.27.095:
Lender information is required(f 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 $ 2:5 CC).it a
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN o HIGHLINE ❑ PRIVATE(SEPTIC)
• •
■ PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESC )
DECK(❑COVERED OR ❑UNCO .RED?) ✓✓✓
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS EXISTING PROPOSED I TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
**NEW HOMES ONLY** NUMBER OF BEDROO ' ESTIMATED SELLING PRICE $
01. FIXTURES
Indicate number of each type of fixture to ;• installed or relocate. • part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE ST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS G• PIPE OUTLETS WOODSTOVES
BBQS FANS GAS ATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOOD commerce
COMP :•S FURNACES RANGES
DUCTS GAS LOG SIi1S REFRIG.SY 'EMS
PLUMBIN
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSEIS(Toilet)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify under penalty of perjury that the. ormation furnished by me is true and correct to the best of my knowledge,and further,that I
am authorized by the owner of the abgye p • to perform the work for which the permit application is made. I further agree to hold
harmless the City of Federal Way as t• any int(including costs, expenses, and attorneys'fees incurred in the investigation and defense of
such claim),which m• : r(tade b • ' • - including the undersigned,and filed against the City of Federal Way,but only where such claim
arises out of the once o // • fi its officers and employees,upon the accuracy of the information supplied to the city as a part of
this applicati• . I 11/
471//1
NAME/TITLE
'
/ i DATE -o
(S re) (Title)
RELATIONSHIP TO . `OJE • Owner ❑Agent ❑ Contractor ❑Architect ❑ Other
❑NEW o ADDITION o ALTERATION o REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES ❑NO UP/SEPA/SU? ❑YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100—January 1,2007 Page 2 of 4 k\Handouts\Permit Application