04-101288 ��tl���E� -COMMUMTy DEVEIqPMEN7'SERVICES
�� � . . 33510 FIRST WAY SOU?H•PO BOX 9718
���s FEDERAL WAY,WA 98063-9778
F���ral��;ray ppR �� 7 ?004 P�RMIT APPLICAT'�ON r`� ��;�',��.;,K,Rp�-_����i614�z9
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Fo�o�«uxa,,�+ITY� F iEDERAL WA`�j1 y1 _ � �^ Z � G � _ � Q ro:
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The ollowin is re uired in orntation-an incorre Iete lycation wiil rtot be acce ted. Please rint le ibI (in ink�or e,
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SITE ADDRE.SS: _ 3��/� �Gy� '17�..L� �j�� SUITE/APT#
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ASSESSOR'S TAX/PARCEL#: _����0 -O�j I�_ SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTION (e.g.:Acme Estafes,Lot I) j/ D
(Attach separate page for Iengthy[egal descriptionJ
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TYPE OF PERMIT(This application): o BUII.DING o PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELEC?'RICAL ❑ ENGINEERING�FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this pernut onluh•
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�`,ac��*-lst Gl�i6?£� �'1? �K �� �N�LT>/f!G ��-1%L,�C,L�G '� fn/Gc.�t��L�
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PROJECT NAME(Name of Business/Owner Last Nam�: �/�.3������
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PROPERTY NAME: PRIMA'RLY'PHONE: �[
OWNER O� -E� O L-�••G 1V !G � [ ^�1 �/�� �7 l q
� MAILING ADDRESS(STREET ADDRESS;�: CITY,ST'ATE,ZIP
�3 33 C�,vc.u�v o�,v7— �i R��vvl.� G� 8�s 3 3
CONTRACTOR NAME '� �L��p COMPANY OFFICE PHONE:
G - �D sc,� l G � .� (2.�3)�3� -9393 /2
ILING ADDRE (STRE ADDRESS;�: CITY,STATE,ZIP CELL PHONE: �
� o t��, n ,��� S c.�,�c Gl� �� (z53)6o� -�7oS
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: EXPIRAT(ON ATE: . FAX NUMBER:
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CONTRACTOR5 REGISTRATION NUMBE2 � EXPIRATION DATE:
(copy of eard required with each application) _ � �
LENDER NAME:
ptr.op.a<evm..�>Ss,000� J�V �� ,L, .��ry t G� DAYTIME PHONE: _
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MAfUNG ADDRESS(STREET ADDRESS;�: 1 GTY,STATE,Z[P
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APPLICANT: NAME: COMPANY OFFICE PHONE:
��J '�'T��.-4�x� �t a� ,�c (�3) P 3 3- z�
MAILlNG ADDRESS(STREET ADDRESS�: CITY,STATE,ZIP _ EVENING PHONE: �
�o � �`l PX-�,e,�, `jP�7 (�? S� I - /3/S
RELATIONSHIPTO PRQJECf: FAX NUMBER:
❑ Architect ❑ Tenant Other(DescribeJ:��x.�,Y�c t. ��v�z,�cr�R �2�3� �3�-y��
CONTACT PERSON FOR THIS PROJECT: ❑ Property Owner Contractor ❑ Applicant E-M IL ADDRESS:
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EXISTING USE: PROPOSED USE: ��/�/lJ
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $
SPRINKLERED BLTILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: O YF.S O NO
WATER SERVICE PROVIDER O LAKEHAVEN ❑ HIGHI,INE ❑ TACOMA ❑ pRIVATE�WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN O HIGHLINE o PRIVATE(SEPTIC)
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� .�''" AREA DESCRIPTION EXISTING S .FT. PROPOSED S .FT. TOTAL
BASEMi:NT
FIRST
SECOND
THIRD
FOURTH �
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? 70TAL EXLSTQIG TOTAL PROP0.SCD TOTAL L7�S[IXG MD RtOP0.SED
"NEW HOMES ONLY•` NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
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Indicate number of each type of fixture to be installed or re(ocated as part ojthis project. Do not include exisfing fixtures fo remain.
MECfiAHICAL
Value ojMechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS�co�«d�� N/OODSTOVES
BO(LERS FIREPLACE INSERI'S RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUC1'S GAS PIPE OUTLETS
PLUMBING
BATHTUBS�o�r�n/snow��co�no� SHOWERS WATER CLOSETS�ra;�<y MISC(Describe)
D[SHWASHERS SINKS � DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS eatt,roomsu,�cs VACUUM BREAKERS ELECTRIC WATER HEATERS
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I eerttfy under penalLy oj perfury that the inJormation furnished by me ts true and correM to the best of my knowledge, and further, that I �
am authorized 6y the owner oj the above premises to perjorm the work jor which the permit appiication is made. I further agree to hold
harmiess the City oj Federal Way as to any claim(including costs, ezpenses, and attorneys'fees irtcurred in the invesfigation and dejense oj I
such c1ai� which may 6e made by any person, including the undersigned,and f:led againsL the City of Federal Way,but only where such ciaim i
arises out of the reliance of the city, including its ojficers and employees, upon the accuracy oj the information supplied to the city as a part of
this application.
NAME/TITLE ��Z�r1�/�'� DATE
(Signature) (TiUe)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect o Other
FOR OFFICE USE ONLY
o NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
BUII.DING SHELL ONLY? ❑YES o NO BASIC PLAN? o YES ❑NO
ZOPiING DESIGNATION CHANGE OF USE? ❑YES ❑NO
NEW ADDRF.SS REQUIRED? o YF,S ❑NO UP/SEPA/SU? ❑YE.S o NO
PLATTED LOT? o YF,S a NO DEMO PERMIT REQUIRED? o YFS o NO
Bullctin#100—March 30,2004 Pagc 2 of 4 k\Flandouts—RcvisedU'cnnit Application