07-104421441' RECElyo
AUG09
Federal way 2007 PERMIT
33325 8M AVENUE
So W PO9!!I,� � Q�'�
FEDERAL WAY, X 98063 -260 C7(JILDING A LI CATI O N
253-835-2607• FAX 253-835-2609 DE�'P
miig_gh n • .mm
T
0
SF MF CO ME EL PL DE EN P
The following is required irtformation - an incomplete application will not be accepted. Please print legibly (in ink) or type.
,•• •. •
SITE ADDRESS 3 S/ 0 o L N C� a N� t, r `Pa r kL-)g L, s i) L -t- �/ $�%t% 3 SUITE/UNIT #
ASSESSOR'S TAR/PARCEL # -�— I 02 l0 o- O 2S O LOT SIZE (s-1)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 11 c o s�-C C (L� 01 e r -T\ VJ ce-i
(Art h s Pia page) tengft legal d—roffoN
•• •• •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlul
PROJECT NAME (Name of Business or Owner Last ST(,) 30-y- T I - 1- e d e r4 l W G N
PEOPLE•• •
PROPERTY
OWNER
CONTRACTOR
COPY of card ngolred
with each appliuHon
APPLICANT
PROJECT
CONTACT
LENDER
r,
NAME
PRIMARY PHONE
MAILING ADDRESS
Ct0(ct I -c e Off; ve
CIY,STATE, ZIP
TSS'r u -7
E-MAIL ADDRESS
COMPANY NAME \
SM:a� STNS, T.c.
APPIICANT AME
C, ✓"X: S1; LIke-1<
OFFICE PHONE
(ZS3 ) 9.2(0 - l is K'0
MAILING ADDRESS
Ilo�-SL{ A -c. 1l-Qst-
CITY, STATE, ZIP
`iFLOY
CELL PHONE
MAILING ADDRESS
)lbt,- Sal vc. �=-cis}
WA
( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
56
19 $7 o00o SS oo Q)-
12/31/07
(.S3 )57-6 - 2- 3
CONTRACTOR'S REGISTRATION NUMBER
EXPIRATION DATE
E-MAIL ADDRESS
'SMTT �\ �-S \ 3 to o t-
I/ A Ss
COMPANY NAME,
APPLICANT NAME
C-'tnAChesl;K
OFFICE PHONE
9.2
CITY. STATE, ZIP
PHONE
(9'53 )
MAILING ADDRESS
)lbt,- Sal vc. �=-cis}
CITY, STATE, ZIP
T0.cv,v�c1 , LOA
CELL PHONE
RELATIONSHIP TO PROJECT_
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent L<Other � � VIA e c
( 253) irk G - Z 3 5 u
NAME PRIMARY PHONE E-MAIL ADDRESS
(2,53 ` _/3` &
��S�l� �5C�.1oec�er 2(�
NAME
Per RCW 19.27.095:
Lender irtfonnation is required (f project value exceeds $5,000
MAILING ADDRESS
CITY. STATE, ZIP
PHONE
EXISTING USE v C 0 C 1 e ( - C j e �t ( c �f PROPOSED USE Co s4(v 'o, f P r
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 1 q : '�DO . C 0
SPRINKLERED BUILDING? xYES O NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? X YES ❑ NO
WATER SERVICE PROVIDER �LAKEHAVEN ❑ HIGHLINE ❑ TACOMA O PRIVATE (WELL)
SEWER SERVICE PROVIDER LAKEHAVEN 0 HIGHLINE O PRIVATE (SEPTIC)
■ PROJECT FLOOR AREAS .! M7
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
SQ. FT.
BASEMENT
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
FIRST
COMPRESSORS
FURNACES
RANGES
SECOND
GAS LAG SETS
REFRIG. SYSTEMS
CHANGE OF USE?
THIRD
c NO
NEW ADDRESS REgUIRED? ❑ YES c NO
UP/SEPA/SU?
ADDITIONAL FLOORS (DESCRIBE)
c NO
PLATTED LOT? c YES ❑ NO
DEMO PERMIT REgUIRED?
DECK (❑ COVERED OR ❑ UNCOVERED?)
c NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
e�Rrrna
PROPOBPD
rOTAL
TOTAL EXWrRVO SF
TOTAL PROPOSED SF
TOTAL SF
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type offirture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work
(ACOP OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS PIPE OUTLETS WOODSTOVES
BBgS
FANS
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
HOODS (c. --w)
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LAG SETS
REFRIG. SYSTEMS
PLUMBING
BATHTUBS (or Tub/Shower Combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
LAVS (Dathroom Sinks(
RAINWATER SYST
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
WATER CLOSETS Iroueq
WASHING MACHINES
MISC (Describe)
I certify under penalty of perjury that the irtjormation 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.
NAME/TITLE
v K�
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect
—DATEt E' — 1 0
t�Other 1 y\AotoUee.
FOR OFFICE USE ONLY
c NEW c ADDITION
o ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY? n YES n NO
BASIC PLAN?
❑ YES
n NO
ZONING DESIGNATION
CHANGE OF USE?
c YES
c NO
NEW ADDRESS REgUIRED? ❑ YES c NO
UP/SEPA/SU?
o YES
c NO
PLATTED LOT? c YES ❑ NO
DEMO PERMIT REgUIRED?
c YES
c NO
Bulletin #100 —January 1, 2007 Page 2 of 4 k\Handouts\Permit Application