05-105691 I an nF • g —
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RECZ N E D, 9 _ IL 54 q j
Federal Way S1 y5 CC
COMMUNITY DEVELOPMENT SERVICES 0A2005 SF MF CO ME EL PL DE EIQ�33325 6'mAVENUESOUTH•POBOX9718 i}
FEDERAL�;:�^ 539 APPLICAT'. I \ Y7e� _ —
23FAX 253 -TTYF rEDEFIAL /
www.cUuo((ederaluau.com
BUILDING DEPT.
The ollowin• is re•uired in ormation-an incom.lete a.•lication will not be acre.ted. Please •rint le,ibl_ (in ink)or _ . ^k\A
• PROPERTY INFORMATION 2
SITE ADDRESS 35 d 07- 53 k " I �0(' G/ i
ASSESSOR'S TAX/PARCEL# 2_ 0 C_ 1 0 9 - 9 0 LI 0 LOT SIZE (sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
!Attach separate page for lengthy legal descnphoN
■ PROJECT INFORMATION
TYPE OF PERMIT D BUILDING 0 PLUMBING 0 MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL 0 ENGINEERING d FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed descriptionofwork included
on_this permit onlu) /' ,� , A
AsI.A,1.1 TZ-rc_ Si firt.Kier SysTCM In FeAerc,1 1.-Jay CAss/11Q1.S ' Q(J�1QIAc4s
C.. cJ mrX. �f �J
PROJECT NAME(Name of Business or Owner Last Name) (7J-V—R Ce . 0 b
• PEOPLE INFORMATION
PROPERTY N,ME0 PRIMARY PHONE
OWNER S N J\TN (v J '� %-d. t ) 1153 i
�_ ;: ,
MAILING AD7KES -
TATE,ZIP
91S 118 AveSE Svat 3(X) Bel4cvLLc WA 96005
CONTRACTOR CAIPANY NAME APPLICANT NAME OFFICE PHONE
6N•..1-f RD F i CC. ?co}ecko n (Z53)9 U . - ZZ10
MAILING 2101 ADDRESS0 -n` A verve Et s r cTacon WA 9592,9 TATE,ZIP CELLPHONE
)
-
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
1 9 - 9 1 - 1 0 1 9 5 6 - B L 1 Z / 31 /2()S (Z53 )`1LZ -61 SD
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
PAT klFY099GF lv / S /Z.036
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
-
( )
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
I ( ) -
RELATIONSHIP TO PROJECT i 1 S CJ �/ , C k 0 f a f' OR f Y&. D AA`
❑ Architect 0 Tenant 0 Agent ❑ Other(Describe)
CONTACTNAME P Y PH MAIL DRESS
66b Fvrsber (/-53) 1 -3405 bte palc ;cc.conn
LENDER Per RCW 19.27995:7095 Lenderin,fdrination is NAME
required>Ff project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION ^' R L ` ,
EXISTING USE PROPOSED USE New l�lck1 Zu7.-._
lQyirt s
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK ` 7. `"` 7 ....
'0
24 Q r csa
SPRINKLERED BUILDING? [YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? /YES ■ ' •
WATER SERVICE PROVIDER VLAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER o LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC) 7,
•
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ. FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
1
ADDITIONAL FLOORS(DESCRIBE) /
DECK(COVERED?) /
GARAGE ❑ CARPORT❑
EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**NEW HOMES ONLY"' NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS// HOODS(Commercial) WOODSTOVES
BOILERS Fjl.EPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS URNACES GAS WATER HEATERS
DUCTS /GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS(toilet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
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. l p M f
NAME/TITLE c 0) COCo 1 CO j e 1`Vt.ltrtige.r DATE 'V U O`3 Z S
(Signature) (Title) J
RELATIONSHIP TO PROJECT o Owner ❑ Agent ❑ Contractor o Architect 0 Other
FOR OFFICE USE ONLY
❑ NEW n ADDITION ❑ALTERATION ❑REPAIR D TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN?` n YES ❑NO
ZONING DESIGNATION CHANGE OF USE? YES ❑NO
NEW ADDRESS REQUIRED? ❑YES ❑NO UP/SEPA/SU? ❑YES ❑NO
PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100-January 7,2005 Page 2 of 4 k\Handouts\Permit Application