06-102961 RECEIVED I v
e rad Way 'PERMIT —
�ERM
COMMUNITY DEVELOPMENTSEEVICES', ii, 4A1SF MF CO ME EL PL DE EN `�'3325 8DERAL UE SOUTH•PO ROY 97.18 �1 PLICATION TD
FEDERAL W07Y,WAFAX
98063-9718-8 -260 / /
253-835-2607•FAX 253-835-2609
Wlalr.CillloffcderalivaiLe OF FEDERAL
BUILDING DEPT.
The ollowin• is re•aired in ormation-an incom.fete a..Tication will not be acce.ted. Please .rint le.ibl (in ink or .e.
W�
(A n - PROPERTY INFORMATION
SITE ADDRESS 2�0 `�' - v(1Cl N A P t'' cLL( C)(A SUITE/UNIT# c)A C }'�
Q
ASSESSOR'S TAX/PARCEL# 2_ I a I O q - (11 O �J Z LOT SIZE (sf)
LEGAL DESCRIPTION (e.g.Acme Estates, Lot 1) ' "t'''t" A c -( ( V
(Hunch separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING [YFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
I`CY Ti r AAA Q(S "A-C.& 4' ,37 S--1-\,1 -ir tA,ve C. 2FSev tc k.C n io) t••V\S i CQQ 4-6 14-t'4 IA 000 recta
O * ? u.)---r- ?Ad,c) • S tWt tprc *O (On ric+c--extS rt W(1(1,014 L(1U,Je-1-Sp✓itn(cle.r S.tS-1 .
+r\b M-10(.,0 Ua 1\t`c.S or SP par-e--e_ c-4-1.<.---40 was I'VT lu4prJ ,
t 1 n
PROJECT NAME(Name of Business or Owner Last Name) v\-./ t Y h tt P to Ne r — Cc ( f Pruitt-r-
• PEOPLE INFORMATION
PROPERTY i ,NAME PRIMARY PHONE
OWNER W-et.( tc)Y ill A'utSs4r C'rto - (2.$ )°I2--I - . 2 1Z
MAILING ADDRESS CITY,STATE,ZIP
33(.0 ro3 L?-ell-PC. .1 S _ Frcc,e .Awa.y ( LU P r TIac�al
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
ttACIL.MS LI CO- LLC `CYntAces avo-PS (2c„)es2 - Fi4Sc1
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
SOC& -1 cA Pue S 46 c yor et 21 ( ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
(,3 - - 23 1 - B L 3 / /6 /osi POC— ) 76,3 5ct67
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
AIC Ic1n f i.- g_ W / /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
S°IV a Cal--\•rz1c-le,,• ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant ❑Agent ❑ Other (Describe) ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
Annk Ic-ew,rt y4 z. (20(,)2S5 - 7 3
LENDERNAME
PereRCN 1i project Lendergue informationeds$5,000 is `,''tc, � ,\k ` v c.
required if project value exceeds �) ( �-,�`4�+•C, .
MAILING ADDRE CIT STATE,ZIP
500L3 (kf I) r')- S , 2U0 Se-eAk w.q4 R so(--i
III DETAILED BUILDING INFORMATION Imo,
EXISTING USE • C �.L ) / PROPOSED USE La_►�
EXISTING ASSESSED/APPRAISED VALUE $ SIC()•U O VALUE OF PROPOSED WORK $ 57
0 0f O 0 _
SPRINKLERED BUILDING? (/YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
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 ❑ CARPORT❑
EXISTING PROPOSED TOTAL TOTAL EXISTING 8F 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) WOOD STOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS IorTub/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.
NAME/TITLE _/'C '16R7 l0 0.9-144-0-0 //0j , I.SnOki' DATE 6/J/1;
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent r7l ntractor 0 Architect 0 Other
FOR OFFICE USE ONLY
o NEW ❑ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES a NO DEMO PERMIT REQUIRED? a YES o NO
Bulletin 4100—January 7,2005 Page 2 of 4 k\I-Iandouts\Permit Application