04-103237 ` , /`1�,.
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' � ��� �'� � �'L-/--c.'L� CONNUNITYDEVEIAPMENTSERVlCBS
f�� 33530 FlRST WAY SOUTH•p0 BOX 9718
p�p� . W Y'{(1 f� FSDERAL WAY,WA 98063•971B
��'������a���' � � �uu PERMIT APPLICATION 253uww4a'tuo�ed a/wau.6rom��9
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The oliow{n is ired in ormatton-an tncom iete a lication w{ii not be acc d Piease rtnt Z tbi in tn or
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sia�annxEss: �3� i�C> i-�-r�t�h� �c� � <`��v�l ��r��L�� ��i��-;�_ ���=�-�$b Z3 svia��nrT�
A38ESSOR'S TAX/PARCEL N: 2% �� U � �J C' � � n2 '✓ � SQUARE FOOTAQE OF LOT:
LEGAL DESCRIPTION(e.g.:Acme Fstates,Lot 1)
o� ����� m� ����,., � (Attach separate page for lengthy legal descriprion)
-• • • •
TYPE OF PERMIT(This applicatioa�: ?BUILDIP(� ?PLUMBING ?,�_�fIICAI�__ _P DEMOLM'ION
P ELECTRICAL 4 ENGINEERING{'FiRL PREVENTIOlY SYSTEM�-
�_ �
PROJECT DESCRIPTION(Provide detailed descripfion of work included on this permit onluF. ��e�u •�L��F('►'✓� ��,�,i�}''
_.�(1����1,�''�' �L�'��-C� �-�.L-�'�h.,� . l� ��,_ � ����ti� S���:�> �� �t�ti� f"��:�f-�
PROJECT NAME(Name ofBusiness/Owner Last Name): I� , f�f� e.✓ C�-���
• • • • •
PROPERTY �E: PRIMAI�PHONE:
owxER: ���v�C�2h,�C1.h �. `.��-C�'��v�.tti�� �e����,:1;� �vti�.. ( 1 -
MAII�NG ADDRESS(SfREg.T ADDRESS;�: C�.STATE,Z[P
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����� N t� i-���1a dati� S+, �( v Rt��G�--ti��C� t.�+2 ��� z�� '�..
y CONTRACTOR: NAME COMPANY OFFICE PHONE: .
���U'�;�.F�Q=�%E?�.� ���C�.'���,�"i'7dC'r���-�tL�v'. �I�C- ���1_c7 ��`�y I_ - `f"Zi?C
MAIL[NG ADDRESS(STRN�T ADDRESS;�: C1TY,SfATE,ZIP r ' CELL PHQIE:
i��i o3 trc> ���, l�v� �t���. u�t.r_�t- r�{.�ti�n„�l� �4tit/10�� ( ) -
Crl'Y OF FmERAL WAY HUSINESS UCENSE NUMBER: EXPIRATION DATE: FAX NUMBER:
,� G' - L� �- i � ',� � � �-li G -P� 1_.. i 2-1 3 � l c�-� (i C 2�)'�l�{ 2 - 2���i��
CONTRACTORS RFTISfRATION N[JMBER: EXPIRATION DATE:
(eopy of card roquirad with each�ppllcatbn) �" �� � �L L� r � F� .�j �� '� `'` �' � � C`�
LENDER: NAME: DAYTIME PHONE:
(u hopsd vNae>�s,000) � � -
MAILING ADDRESS(SCRF�.T ADDRESS;): CITY,SfATE,ZIP
APPLICANT: NAME: COMPANY OFFICE PHONE:
`' � � � I{G1{I��� � `� � �i-���'�) ��l � ' ��f ���
�i P-t i �.�v C-� 2iti�-��:��l� � 1-1������ ��� c �
MAILINO ADDRESS RFET ADDRESS�:, CITY,SfATE,ZIP , EVENIN(3 PHONE:
��.�,2.(, i�'�,� ��: �iti(.FIL �_LL��' �t.�2r�E(.L. �l,'�� �1�<<'`� (�1.�Co)���j�; - �C,2��� �
RELATIONSHIPTO PROJECT: � FAX NUMBER:
P Architect ? Tenant � ? Other(DescribeJ: ���� �1� ��l � �,l.�V (��) 2� ( - � �;�
COMTACT PERSON FOK THIS PRO.IECT: �Property Owaer P Contractor Applicant E-n�a[t,nnnxess: ._ ; � ;
'�4�12 e.�e�a�EyCo,.� ,L• m
� � : � • • •
EXISTIIiG UBE: PROPOSED USE:
EXISTII�iG ASSESSED/APPRAISED VALUE � VALUE OF PROPOSED WORK: $ � ��L • C L
� SPRINKLERED BUII.DINQr? P YE8 P NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: P YE8 ?NO
WATER SERVICE PROVIDER P LAKEHAVEN ?HIGHLINE ?TACOMA ?PRIVATE(WELL)
SEWER SERVICE PROVIDER: ?LAKEHAVEM ?HIGHLINE ?PRNATE(SEPTIC)
•. .. -
AREA DESCRIPTION EXISTING .FT. PROPOSED S .FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FIAORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? Taru�asnpc �ror,u.rnoeosen trn'Atiewsrnaam+or�nsea:
*'NEWHOMES ONLY'* NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
Indicate number of each type of fixture that is to be instalied or relocated as part of this project. Do not include existing fixtures to remain.
MECXAHICAL
Va1ue of Mechanica!Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS�commerc�eq WOODSTOVES
BOILERS FIREPLACE INSER7'S RANGES MISC(Describe)
COMPRESSORS FURNACES QAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BA7'HTUBS�anb�snoaQcombo� SHOWERS WA1`ER CLOSE7'S�ro��� MISC(Dexribe)
�,_. DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLE'fS SUMPS RAINWATER SYS
WASHING MACHINES UR[NALS HOSE BIBBS
LAVS(Bsthroom9ink VACUUM HREAKERS ELECTRIC WATER HEATERS
I certtfy under penaity of per}ury that the tnformation furnished by me is true and correct to the beat of my knowledge,
and further,that I am authorlsed by the owner of the above premises to perform the work for which the pern�it appiicatlon ts
made. I further agree to hold harmless the City of Federai Way as to any ciatm(�nciuding costs,expenses,and attorneya'fees
incurned in the tnvestigatton and defense of such ciaim), wh{ch may be made by any person,inciuding the undersigned,and
fiied agatnst the Ctty of Federal Way,but only where such claim arlses out of the retiance of the c{ty,tnciudtng its officers
and employees,upon the accur+acy ojthe lnforntatton supplted to the ctty as a part of thfs applicatton.
� �
� NAAdE/TI'f7.E: ,�<��Cl,� ����,,�.�_� /�6 � ��2-�lt����}����. ��-�,-��'� DATE: � ��'- C'' L
(signeture) - ,'� ,.,` - (fitle)
RELATIONSHIP TO PROJECT: � Froperty Owner l? Applicant ? Contractor ? Architect ?
1rQtt,OFFTCE tT81�'O�1'LY
?NEW_ ?ADDI"1i01� ', ?AL1'ERATIOI�i ' ?REPAIR ?TFI�ANT III�PROVEMFNT
'BUILDIN(i SHELL ONLY? ?YP� P AO' BABIC PLAN3 ?YES P'1�0
ZONIRQ DESltiliATION: CIiANGE OF L18E�^ ?YEB ?'1t�
NEW ADDRESS REQUIRED? ?YES ?!t0 UP/SEYA/t3U? ?YEB ?!tQ
PLATTED LOT? ?YES ?1�f0 DEMO PERMIT REQUIREI)? ?YES ?170
Bulletin#100-January 13,2004 Page 2 of 4 k:�Iandouts-Revised�Permit Application