07-101500 '''''1..7 Alb, III •
RECEIVED
FeFieral Way PERMIT
i.iMMUM71'.-EYELOPME,NTBEavrcE NAR 2 ( �� sF MF CO ME EL PL DE EN FP
333iw TERAI.p`UE•SOFAX 25•
063-97 09 PO BOX 'LI CATI 0 N
Fa',DERAL NAY,WA 98063-9718 ��ii �� ;�- �
25s.g3u-2607•FAX 253-835-2609 AS 7_
www.e.offederalway....1 TY OF FEDER �1 9.
EiU1LD(NG DEPT.
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
�/ �_:�
SITE ADDRESS - f ..6.
h A SUI'1'E/UNIT'#ASSESSOR'S TAX/PARCEL# 0 C 2- \ 9 ® LOT SIZE(sf) J
✓J 121 .
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)O5..2i -{ 37 d,W1j.U j N 15+(' 5'g2,471-c W lit U SW lki
(Attach separate page for lengthy legal de, ription) v rt (v 4 lYA1M
V/1
■ PROJECT INFORMATION `�%'
TYPE OF PERMIT A BUILDING ❑ PLUMBING ❑ MECHANICAL
•❑ DEMOLITION ❑ ELECTRICAL E ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
c rr i _a c�v Con tai,l.e n__i' i t i�ca, �G�cn� �Ur(00
_fes ildae rt i`&; -,r tet' -- �/
/s o 4-4?-, A-,-f.
PROJECT NAME(Name of Business or Owner Last Name) i / -i,, i-r/)0 y',' 51/10'J 'o' 7. 10(4T (12C lc2tl i(1�7 (.,,.) (f
1
II PEOPLE INFORMATION
PROPER NAME Q J�i L'' I _ PRIMARY PHONE
OWNER ) Vet B-On(* kf / ! I Irk P-AvciL'YIK0 (a53) 1(11 -3 l
' )-�.--
---- MAILING ADDRESS CITY,STATE,ZIP (-,8030 E-MAIL ADDRESS
. k. i )50 - 5f isq+h PI den /W -, 30
- '• • E APPLICANT NAME OFFICE PHONE
" .dit i , lii(,rl fxra i.�77h� (k shit_i zu- (2,53) 77 -o334-1
,`�-IN)G ADD S O CI1Y, /) ZIP4 r�� CELL PHONE
I ! 4.4 7 OF FEDERAL WAY BUSINESS LICENSE NUMBER '/JV,/u- EXPIRATION DATE IFAX NUMB/ER -
(>(� — / 1(,26e.0— (90 /�,/l3/ 67
Co cr card req ee CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DA E-MAIL ADDRESS
with each applies ... / 1l 1 s 2 SE .{c 1 A01-110 9
APPLICAN V X COMPANY NAME APPLICANT NAME OFFICE PHONE
Paul 5(0)1 5(0)11i-ski Y ( -
MAILING ADDRESS CITY,STATE,ZIP I CELL P ONE
//51), - 5Z /3-41-1-Pi �.t,wA €0030 0 ) -"i 1 - 3a31
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑ Tenant 0 Agent *Other btUae..4 ( ) -
PROJECT N //��,, ` PRIMARY PHONE71 E-MAIL ADDRESS
CONTACT " EatiI 13YDn1 fSki v' (.53) fit 3- a'�-3 1
LENDERN Per RCW 19.27.095:
-1&)Lindn.k_.. Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
oVI S. qty. '; .0' _,..l v . _Lo __ A>> cti . ,5 (v2s.3 )529 - 4/00
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ 7/ VALUE OF PROPOSED WORK $(2 000. 00
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO
WATER SERVICE PROVIDER E LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER C LAKEHAVEN - ❑ HIGHLINE C PRIVATE(SEPTIC)
CA) OS-/ozSSf•- mac_ ( 3f0
■ PROJECT FLOOR AREAS
ti to
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. sg.FT.
BASE MENT
FI QRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑ COVERED OR ❑UNCOVERED?)
GARAGE 0 CARPORT 0
EXISTING PROPOS TOTAL TOTAL=STING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBER OF BEDROO S ESTIMATD 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 $ (A COP OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORA+ COOLERS G��AS,PWPEIOUTLETS WOODSTOVES
BBQS FANS ,6A5 WATER HEATERS MISC(Describe)
BOILERS FIREPLACE SERTS HOODS(commermal)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SEAS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroo, sinks) URINALS MISC(Describe)
DISHWASHERS RAINWA SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHO WATER CLOSEIJ(Fot(et)
ELECTRIC WATER HEATERS SIN : WASHING MACHINES
HOSE BIBBS S PS
SIGNATURE
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.
NAME/TITLE �• ' DATE 3)ZOic
(Signature) (Title) CC
RELATIONSHIP TO PROJECT ❑ Owner 0 Agent 0 Contractor 0 Architect 'Other Zi(2CgWr1Q.0
FOR OFFICE USE ONLY
❑NEW [L ADDITION Li ALTERATION ❑REPAIR c TENANT IMPROVEMENT
BUILDING SHELL ONLY? c YES ❑NO BASIC PLAN? a YES c NO
ZONING DESIGNATION CHANGE OF USE? ❑YES NO
NEW ADDRESS REQUIRED? c YES ❑NO UP/SEPA/SU? ❑YES c.NO
PLATTED LOT? ❑YES c NO DEMO PERMIT REQUIRED? o YES c NO
Bulletin#100—January 1,2007 Page 2 of 4 k\Handouts\Permit Application