06-103525 RECEIVED
C.9CP- ♦ 3 b o.5..�
anon A JUL 1 8 2006 -
Federal Way
CITY OF FEDERALVgRM IT SF MF CO . LPLDEENFP
coMMiJMTY DEVELOEMENT SERVICES
333258TM AVFSYUE SOUTH•PO BOX 9718 BUILDIN
FEDERAL WAY,WA 98063-9 718 L I C AT I ON
253-835-2607•FAX 253-835-2609
www.c5uoffederalwau_corn
The ollo a is re• bred i ormation-an in..', •lets • ••lication will not be aces•ted. Please • t le! , - i or t-f• .
• PROPERTY INFORMATION
SITE ADDRESS a,^al - % - 7z A'h
SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# j 0 7 0
- * t5 IL LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Anne Estates, Lot 1 i ) 1‘411...
N�
(Attache/Tonne pope for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PR Olf Ovide detailed descr' n o work included on this permit only)
Ihi2df��)1?n o� GI. 1� 41. �'-1. S TvkyL
PROJECT NAME(Name of easiness or Owner Last Narm) --0 J r, I
PROPERTY NAME �/,L A 171tijr
PRIMARY PHONE
iOWNER 0 0411 )lUI ?, , ( )
MAILING ADDRESSJCITY, A ZIP
)-lo 71 So- 3O St th' ra l WQ `I l ' (1'10)3
CONTRACTOR COMRANY NA +- r APPLICANT NAME OWFICE PHONE.
bite l' a C 6th,' ( jlo ) a(45 -iv
MAILI 1 (o 4e (/�//Pftitlhit
mill (v "��M��,1r &)11 ,Z lip) Qf 10' i3O�NEI'J poCITY OF EDERAL WAY BSINESS LICENSE N MBE EXPIRATION DATE FAX NUMBER
111--A -: a iii 6.. (L-$ L Iz / '71101a ( )
CONTRACTOR'S REOISTRATION NUMBER(espy at oval rpvina with snob application) EXPIRATION DATE
APPLICANT COMPANY NAME I 1 APPLICANT NAME OFFICE PHONE '
(491°
,,, e),_ .1 „17�ADDRI+,'1'^ 7�, y C STAT Z vi q n it i CELLPHONE MAIL
REIA'"IONSHIP TO PROJECT 'V C 2�I l/ �� ,0 ((i/f !\FAX NUMBERJ`
❑ Architect ❑Tenant ❑Agent 0 tither(Describe) CO n stAGt Y (•. ) A 4 - g3 41
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
�p1;ai-' (J, ) v (: .. ) (00- a rK l
LENDER Per RCW 19.27.095: Lewder tMorrwation is NAME
requited 4f project valve exceeds 0.000
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? o YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES o NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE o TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER o LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
6001;Y/Rig`
s
,
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
LI301910 PROPOS= TOTAL TDTAL glisrmW S TOTAL PROD 0 TOTAL S
NUMBER OF FLOORS
**NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture
f to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL (IQ
Value Mechanical Work $ W 1 l 0
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG. SYSTEMS
BBQS FANS HOODS(commerce WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe) /
COMPRESSORS FURNACES GAS WATER HEATERS �Viy
DUCTS GAS PIPE OUTLETS 'V _ I''�
2M
PLUMBING
BATHTUBS(orTub/Shower Combo) SHOWERS WATER CLOSETS rrmteq MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAYS(snihroomsmb) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I cert(fy 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 authorised 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/TITLEI V Vr✓ ,�i r `�,� fi W/ DATE V T I i 0 1 V
(a gnature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner 0 Agent o Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
o NEW a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL OILY? a YES a NO BASIC PLAN? a YES o NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO IIP/SEPA/SII? o YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES o NO
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application