06-105328 RECEIVED
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CITY OF 012 - 10 5 5a 2
Federal Way CITY OF FEDERAlitSI RMIT
COMMUNITY DEVELOPMENT SERVICES BUILDING DE 1 SF MF ME EL PL DE EN FP
33325 8rH AVENUE SOUTH•PO BOX 97]8 Ap p LI C AT I O N 7u it /vs,
FEDERAL WAY,WA 98063-9718 jr,
/04
253-835-2607•FAX 253-835-2609
www.citijollederalwau.com
The ollowin• is re•uired information-an incom,lete a,•lication will not be acce•ted. Please •rint le•''1 (in ink)or ,•.
al PROPERTY INFORMATION
SITE ADDRESS �)3 1 , 4‘- _-c g2.5 ;
/� ITE/ #
ASSESSOR'S TAX/PARCEL# 21Z_I D`T -'IL. ww • " /' i I it& LOT SIZE(sj)
10-11
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) � _- A C,�t�n
(Attach separate page for lengthy legal desc.iptbN
MI PROJECT INFORMATION
TYPE OF PERMIT VrftUILDING XpLUMBING )(MECHANICAL yJ'/0 f
ek(O W XDEM LITIIONN ELECTRICAL)❑ ENGINEERING )-FIRE PREVENTION SYSTEM
PROJECT I CRIPTION(Provide detailed description of work include. on this Sere-i•-•-'4c••-s-
onl~iRMS ,�
:, 1 kti Sri .' - I ICC ") i e: .a A AA Y✓Y) An a-v- /(?t Vic'-
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1 i
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� `> rGiGGtA� )6&i'1r .ex / Vl (1l,Y'•( V%-t41
'' a T NAME(Arne of Business :r Owner Last Name) Li(I.,-,1-tile,/ t CIVS. -5 t' r•y' L .i-
al PEOPLE INFORMATION
PROPERTY NAME
}+�. �A��> ,..3.-.AA
T fA PRIMARYi
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OWNER fir. G ADDRESS }-N I j I t6 J '\/l i .,4&t 1 11 o v' (7w C3O - ---30e)
CITY,STATE,ZIP
i •-f--A,. J.ti 44- 140 (AV kAo ( - 1'200y °;91
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE ��'
• 't43R :14 (of sr to . 1 r. v►S Ru'sr ( 73)�'`1 s -F,- ..5/
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
'21 660 NW AtuFr va- Pg i-fli i-43o 20 Oe, (11121 (66(73)Cl,.q -c/07
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
20 -o -.1. a L 4_ C. 1_.-B L X2 / 31 /QU (1v9646 - b; 57
CONTRALIUR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
.gc B i h� :C c- L 2 L 5 / c1 /0S
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
ME. 1 talc/ IVLIS.gow-kAc�l 103
. .2G10
AILADDRESS CITY, � PHONE
2Z1 ZJ Try' Ave `. .4ts T1 4k.• UV/c d1w2 a (/r2 ) -
RELATIONS IP TO PROJECT FAX
Architect o Tenant 0 Agent ❑ Other(Describe) (4-'0))92.._-1NQ„(I,I
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS V
L--AOC , 0 r-LiC/it c1-t (4 2 '21 - .2.9r30 Y�- j o►-1(c h@J Esc - At.
LENDER Per RCW 19.27.095: Lender,information is NAME
required IIf project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
) -
IN DETAILED BUILDING INFORMATION
EXISTING USE 1 r '-LAN 1-t- I Lit., PROPOSED USE ?iE A^1
VT]LF
EXISTING ASSESSED/APPRAISED VALUE $,O /t) f VALUE OF PROPOSED WORK $ q il i c/0
SPRINKLERED BUILDING? YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES a NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WlsLL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
yvvc9y,13
• 0
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
BASEMENT - _ sq.FT. Sq.FT. SQ. FT.
FIRST P�oova! [ 6 / � 6 7 �^ , 7
SECOND [1T/'9 L� ... �7 RiculituNc; ' i L, 11 C 1 c,1 t .50
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE) E A,�I N ? � ll L)
r
DECK(COVERED?)�x i JTC t C1! /-24
GARAGE ❑ CARPORT❑ V
NUMBER OF FLOORS c�sr�c PROPOSED 7u TOTAL S. TOTAL PROPOSED SF ncsv
417Z 1171 1
**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(commeretan WOODSTOVES 1
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLEIb !�'
PLUMBING O
BATHTUBS(or Thb/Shower Combo) SHOWERS WATER CLOSE Ib(Toilet) X MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLUlb SUMPS RAINWATER SYST 11;�0 `
WASHING MACHINES URINALS HOSE BIBBS �� t v
6.3
LAYS(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 . •. employees upon the accuracy of the information supplied to the city as a part of
: : 2
a0� � 0, • ��
DATE C�� / i
0
(Signature �...._,_ Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent ❑ Contractor gLArchitect 0 Other
FOR OFFICE USE ONLY
a NEW a ADDITION a ALTERATION a REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN?: a YES 0 NO
ZONING DESIGNATION CHANGE OF USE? a YES ❑NO
NEW ADDRESS REQUIRED? o YES' a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? 0 YES ', a NO
Bulletin#100—January 1,2006 Page 2 of 4 k\F-Iandouts\Permit Application