04-106159 RECE►vtu
COMMUNITY DEVELOPMENT SERVICES
33530 FIRST WAY SOUTH•PO BOX 9718
CITY �� JAN 2 0 20 • FEDERAL WAY,WA 98063-9718
Federal Way 0F, MIT APPLICATION 253-661-4115.FAX:253-6614129
www.cit a edernlwar.com p
G I Y OF FEDCRAL WAY ` //``�� / /' / TO
: `,�/
For Office Use Only: rmfltt iGll 1� �� 9' — 1 0-i� V J - / /O / 0
The ollowin• is re.uired in ormation-an incom•lete a.•lication will not be acce.ted. Please .rint le•ibl (in ink)or .-.
.G 4 - n ■ PROPERTY INFORMATION -
SITE ADDRESS: L Sp$S , /,-hi r y eel, 50. SUITE/APT #
ASSESSOR'S TAX/PARCEL #: 0 1 z ) U - L' C 3 '2 SQUARE FOOTAGE OF LOT: a 96/
LEGAL DESCRIPTION (eg:Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT(This application): IVIEtUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION
0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu): RE774'ln/,4/Ct w,9-4.L
Prete/r
PROJECT NAME(Name 0 Business/Owner Last Name): a-` .. Ve _L& S
• PEOPLE INFORMATION •
PROPERTY NAME: / PRIMARY PHONE:
OWNER ,Ter-,-- 7 .28E‹ /Nit/rtif 4/TMS (
MAILING ADDRESS4STREET ADDRE S;): CITY,STATE,ZIP
/2/ SPea y S' . ,4r2 -0 -in ?ang sc:�i (A 9-1/o.� 'S-3 Z
CONTRACTOR NAME / COMPANY OFFICE PHONE:
> r Pe:, Co..tsrl c.r�or) (is 3 ) S3� -2,/OD
MAILING ADDYKESS(STRE ADDRESS;(: CITY, TATE P CELL PHONE:
_3-C� 8S Pc? 3o - / µ(� W9- 5607/ (2* )SS/ - /4/&
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: EXPIRATION DATE: FAX NUMBER:
L a - -2 5 o v o c2 - e2 ai.. t2 / ,( 4,4 (253 ) `yi, - dfeec
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:•
(copy of card required with each application( ' 0 e C 0 l 2. 7 • // / / CIt
.
LENDER NAME: DAYTIME PHONE:
(If Proposed Value>$5,000) ( ) -
MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP
APPLICANT: COMPANY OFFICE PHONE:
771
,� .- 4AisrA•✓clar) ( ) -
M ILING ADDRESS(STREET ADDRESS): CITY,STATE,ZIP EVENING PHONE:
5470 itc AAP df, (20(' ) ?5/ - 15'/6O
RELATIONSHIP TO PROJECT: FAX NUMBER:
0 Architect 0 Tenant agA6ther(Describe). CON'7 dP4Grdlf-- ( ) -
CONTACT PERSON FOR THIS PROJECT: 0 Property Owner I• Contractor (Applicant E-MAIL ADDRESS:
I ff l �rbir-GoNsriverg)•►.torn
• DETAILED BUILDING INFORMATION• -
EXISTING USE: PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: ❑ YES 0 NO
WATER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE ❑ TACOMA C] PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
(Pi Yb9379 5,
• PROJECT FLOOR AREAS
AREA DESCRIPTION 1-----EXISTING SQ.FT. PROPOSED SQ. FT. TOTAL tk„
BASEMENT
FIRST 14111164.
r =
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EXISTING TOTA •OPOSED TOTAL EXISTING AND PROPOSED
"NEW HOMES ONLY" NUMBER OF BEDROOMS: ESTIMATED S ING PRICE: $
• FIXTURES
Indicate number of each type of fixture that is to be installed or relocated .. p of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE CO• ERS GA LOGS REFRIG.SYSTEMS
BBQS FANS HOO' (commercial) WOODSTOVES
BOILERS FIREPLACE I :ERTS RANGES MISC(Describe)
._COMPRESSORS FURNACES GAS WATER ATERS
DUCTS GAS PIP. OUTLETS
PLUMBING
1
BATHTUBS(orrun/sh000rcombo) SHOWERS WATER CLOSETS rroaet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYS
WASHING MACHINES URINALS HOSE BIBBS
LAYS(Bathroom Sink 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 emplo. -es, upon the accuracy of the information supplied to the city as a part of this application.
NAME/TITLE: WI.. A DATE: )/i0 4/i
(Sig ) (Title)
RELATIONSHIP TO PROJE1 0 Property Owner 0 Applicantntractor ❑ Architect ❑
•
FOR OFFICE USE ONLY:
o NEW o ADDITION ❑ALTERATION a REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION: CHANGE OF USE? o YES n NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? ❑YES a NO
PLATTED LOT? a YES ❑NO DEMO PERMIT REQUIRED? ❑YES o NO J