06-102580M.-,� -22-'2006 16:21 P.02
RECEIVE! //� //'�\
CITY OF A � -' _ � 1 .' � ✓�
Federal way PERMIT �/ ' ` �J
COMMUNITY DEVELOPAIENTSER VICES A�.Y 2 2 "1006 SF MF CO ME EL PL DE EN FP
333258n�Rn AVENUE WA, OUTH VVA9•POBOX 9718 18 PLICATION
FEDERAL WAY, WA 980639718
253-835-2607• FAX 253 835.2684. OF FEDERALY
row w.cf nro)Tederalu,a u.�om
BUILDING DEPT.
The following is required Wartnation - an incomplete application will not be accepted. Please print lealblu lin ink) or tune.
SITE ADDRESS
J SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # _ - LOT SIZE (sf
* LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
IAnach sepnrew rxW,fo k,gft icgu!descrq�IWN
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PPLUMBING ❑ MECHANICAL
❑ DEMOLITION "LECTRICAL ❑ ENGINEERING F FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on tits Dermtt onitI
PROJECT NAME (Narne of Bustness or Owner Last Name) & N lop- PACI FI C, 511rN K — Cr6s�'I N LS C�rut1J `F I-
PEOPLEIM • •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
NAME/1
euig I �� /` c- � 'z--
PRIMARY PHONE
tK` 1F-�1 9z(, - oov
MAILING ADDRESS CITY. STATE. ZIP
/419 Lia C4'Ac 1fvr4-7&U— 1 Tete !?- i,vR- 9g yoZ
COMPANY NAME
5M Y7'iZDc_ �'gCIFI -gC
APPLICANT NAME
1? ,► V✓11-4
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
3a 64.7-f .s t ��
T" -m t� � /4 981-121
(7-5-3) &0(-, - l zo 4
CITY OF FEDERAL WAY BCJSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
/ 9- 9 9 -_/ 03 -B
/.:;z/ 3/ /0&
(-z-" 6,27- llcZZ
_o _S _G
L
E-MAIL ADDRESS
CON"H2ACTOR'S REGISTRATION NUMBER (copy of card required
with each application)
EXPIRATION DATE
Ci A/ / •T P W, 9-V e J)
.
3/ a 7 / CB
COMPANY NAME
t LIQ ��IFiL-T�iG4 Ii
APPLICANT NAME
t� V /ILLt�"i��
OFFICE PHONE
(�✓/� � �-_/V��
MAILING ADDRESS
toi ►I'LL f
CITY, SCATL•'. "LIP
T LOyVI)� &� I Zl
CELLPHONE
(?�3) �o�
� f
- j2 C Y
RELATIONSHIP TO PROJECT /�
❑ Architect` ❑ 'Tenant ❑ Agent ar" they (Descrd)e) �4(.0 _`5 c n s,LAt 7RN
FAX NUMBER
( -1j3) & L7
- ((p -1,Z
NAME
PRIMARY PHONE;
E-MAIL ADDRESS
Per RCW 19.27.095: Lender igrbrinationis
required (f project value exceeds $5,000
NAME
MAILING ADDRESS
CITY, STATE. ZIP
PHONE
EXISTING USE ROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ UE OF PROPOSED WORK $ )
SPRINKLERED BUILDING? ❑ YES N'NO FIRE SUPPRESSION SYSTEM PROPOSED/RE9UIRED? o Yes
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE a TACOMA u PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
f r,ca)
M jY f22—'2006 16 : 21
PROJECT FLOOR AREAS
P.02
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
SQ. FT.
BASEMENT
EVAPORATIVE COOLERS
BBQS
FANS
FIRST
FIREPLACE INSERTS
COMPRESSORS
FURNACES
SECOND
GAS PIPE OUTLETS
CHANGE OF USE?`o YES
❑ NO
THIRD
o YES o NO
UP/SEPA/SU? o YES
o NO
FOURTH
a YES o NO
DEMO PERMIT REQUIRED? o YES
0 NO
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED?)
GARAGE ❑ CARPORT ❑
NUMBER Ole FLOORS
EXISTING
'a-05-
TOTAL
Toru. Ex -0 eF
TOTAL PROP =8F
TOTAL BF
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
SHOWERS
Value of Mechantcal Work $
SINKS
AIR HANDLING UNITS
EVAPORATIVE COOLERS
BBQS
FANS
BOILERS
FIREPLACE INSERTS
COMPRESSORS
FURNACES
DUCTS
GAS PIPE OUTLETS
BATHTUBS IorTUb/snowerCombo7
SHOWERS
DISHWASHERS
SINKS
GAS PIPE OUTLETS
SUMPS
WASHING MACHINES
URINALS
LAVS sm"I
VACUUM BREAKERS
GAS LOGS
HOODS ICommemlall
RANGES
GAS WATER HEATERS
WATER CLOSETS rr lteo
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I certM under penalty gf 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 gf the above premises to perform the work for which the permit application is made. I further
pp agree to hold
harmless the City 4 f Federal Way as to claim (including costs. expenses, and attorneys' fees incurred in the investigation and defense of
such claim), which may be made by an on; including the undersigned, andfiled against the City gfFederal Way, but only where such claim
arises out gf the reliance gf the city, i to ino its officers and employees, upon the accuracy of the irtformation supplied to the city as a part gf
this application. /%
-71 I `V-NT7ep GTD,-- (�51 LT7 ATE
mdel
❑ Owner n Agent M Contractor o Architect o Other
FOR OFFICE USE ONLY
o NEW o ADDITION
❑ ALTERATION
o REPAIR n TENANT IMPROVEMENT
BUILDING SHELL ONLY?
a YES a NO
BASIC PLAN? ❑ YES
o NO
ZONING DESIGNATION
CHANGE OF USE?`o YES
❑ NO
NEW ADDRESS REQUIRED?
o YES o NO
UP/SEPA/SU? o YES
o NO
PLATTED LOT?
a YES o NO
DEMO PERMIT REQUIRED? o YES
0 NO
Bulletin #100 - January 1, 2006
Page 2 of 4
k\Handouts\Pennit Application