05-103450 ��c�iv��
r
� JUL 1 5 2005
�" e E AY �� - ._L_ � .,� .�� �
Federal Way ��, ���
. COMMUMTYDEVEfAPMENfSERVICES SF MF CO ME EL PL DE EN P
, ���.. 33325 BTNAVEMIE SOCIfH•PO BOX 9718 AP P LI CATI O N
� FEDERALWAY,WA 98063-9718 / /
� 253-8352607•FtLY 253-835-2609
www.cituo(federaiwau.com
The ollowin is r uired i ormation-an inco lete a licatlon will not be ted. Please rint ie ibl Cn in/�or
• � • � . • •
srrE nnnxEss _ �I b� C�EDOt�(�O ��`f �O TH s�/uxrr a t��.A.
AS3ES30R'S TAR/PARCEL# O � � � O �- � C7 a C� LOT SIZE(s�
LEGAL DESCRIPTiON(e.g.Acme Estntes,r.�t i� S��q- O�t�1rc �4 O� SC-C,.S,-[�P,'�1�,1 pr E•h.G �,.�•1�,
Gtaach sep�are aagela�„gn,y�eyat desaipnwp
• • y r � •i r• �
TYPE OF PERMIT ❑BUII.DING ❑ PLiTNIBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING �FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detniled description of work inciuded on this permit onlu)
1�IST��,L hl��, ���2^ SPR��l1L�R SYSTEI�/1 � t��P,� 13 (�
�O FZ t��1�1_V �bN ST��l 1CT�1� Sl�•l C l� F�M lt�l 12 1 DEI�,C:',E= •
PROJECT NAME(Name of Business or Oumer Last Name) b LS Ot�l ��S�[,�E�C,F
� � � •. • .
PROPERTY N�E PRIMARY PHONE
��R O R- O S ►�1 c2o��roso -3 bga
� MAII.ING ADDRESS CT1Y.STA1E,ZIP
aq �oa Do�1t�o 1�i`C • R,�. ��c k�.�9Q,do
CONTRACTOR COMPANY NAME ApPLICANf NAME OFFICE PHONE
� \�c QIOt�,1 Jt��"cPH���1�1 �253)�3 -1-1�b
MA[LINGADDRESS�J�g �' .S�� � C11Y,STA1E,ZIP CELL PHONE
'FoSDIf� DR•1�1�1. Sv�T� � 1 p� gDR ( �) �. - \
C11Y OF FEDERA[,WAY BUSIN LICENSE NUMBER EXPIRA170 DATE • FAX NUMBER
2 � -0 1 -1 2 a g �2 a -B L (�.i 31 ioS (253)�3s3 - 589a
CONiRACT'OR'S REGISIRATION NUNffiER(copy o[oard reqvlred wlth each applicatlon) EXPIRA110N DATE
� P RLt� � P �. 1 � L S � i �c� io�o
APPLICANT COMPANY NAME APPLICANf NAME OFFICE PHONE
S P��, S CO ( 253)8�3 -11�0
MAQ,ING ADDRESS CTIY,SfATE,ZiP CELL PHONE
� � _
REIAT70NSHIP TO PROJECT F.4X NUMBER
❑Architect ❑Tenant ❑Agent �Other(Describe)�1���1�TP�C��{Z- �2�3��Sg _sp�b
CONTACT N�IDSt �1 (��)C7S3 _ I�v �Mnn,n�n�ss
U
LENDER �Cp�9 27OHd��«L��i�ja�rni�nr�is���'' xntnE
,` utr d�.�,�r�vatuc�as�a"�aoo �< �..
; � ��
. MAII.ING ADDRESS CI'lY,STATE,ZIP
1 • 1 ► : 1 � 1 1 � ' •
ERISTING USE ��[r'--�L,IC �4M,I L�I ��51 D I�C� PROPOSED USE S�M�e,
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORg $ �i ��'O • C�C.�
SPRINKLERED BUII.DING? �/YES ❑ NO FIRE SUPPRES3ION SYSTEM PROP08ED/REf,�UIRED? C9'YES ❑ NO
WATER 3ERVICE PROVIDER �/LAKEHAVEN ❑ ffiGFII.INE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER �0 LAKEHAVEN o HIGHI,IIVE o PRIVATE(SEPTIC)
r�
' � �• �
AREA DESCRIPTION ERISTII�iG PROPOSED TOTAL
S .FT. S .FT. S .FT.
BASEMENT
FIRST
SECOND
'THIRD
FOURTH
ADDITIONAL FIAORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
NUMBER OF FLOORS suaraia erzoroem ror.w ca 'mr.v.'�twsm�er��.� �io�e�� eoem�r x��r�„'Fnm+v.a�g�� �:
�
.,.a:��o.�aa,,,s-.. �n�e'e: :,�:. °'� .�:�. ,.������..����..,a'�'����:=.�viw�
••NEW HOMES ONLY'"* NUMBER OF BEDROOMS ESTTMATED SELLING PRICE $
Indicate number of each type offiYtwe tn be installed or relncated as part of Hzis project Do not include exi.sting.f'urtures tn remain.
ffiEC,IiANICAL
Va1ue of Mechanical Work $
AIR HANDLING UN1TS EVAPORATNE COOLERS GAS IAGS REFRIG.SYSTEMS
BBgS T'�S HOODS�com�reiau WOODSI'OVES
BOILERS FIREPIACE INSERT'S RANGES MISC(Describe)
COMPRESSORS FURNACES GA9 WATER HEATERS
DUC'I'S GAS PIPE OUI'LETS
PLUMBIIVG
BATHT[7BS(orluh/shoaer comto) SHOWERS WATER CIASETS
�roaeq MISC(DescribeJ
DISHWASHERS SINKS DRINKING FOUNI'AINS
GAS PIPE OUTLEfS SUMPS RAIIVWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS�gattvoom smks) VAC WM BREAKERS $LSCTRIC WATER HEATERS
� 1 1 •
I cert�Jy under pennity of perjury that the injormatton jurnished by me is true arid comect to the 6est oJ my kno�uledge,and further,that 1
am authorized by the owner of the above premises W perJorm the work for which the permit applicatian is made. I further agree to hoid
harmiess the City of Plederal Way as to any claim(including costs, expenses, nnd¢ttorneys'fees incurred in the inuestigatinn and defense of
such clairra,which may be made 6y any person,inciuding the undersigned,end fi[ed against the City ojFledernl Way,bat oniy where such ciaim
arises out of the reliance of the ctty,inc o„Q4cers and empiogees,upon the accuracy of the ir4formation supplied to the ctty as a pnrt of
this appiication.
NAME/TITLE � DATE � � 'S ��S
(Title)
REI.ATIONS O P OJECT ❑ Owner �P,gent ❑ Contractor ❑Architect ❑ Other
a�.; _-- ��- - „
�7;� s�' r�- �a��
i�3.NEW��� s� ��fDDTTIOPF�x ❑ALTERATIQN n REPAII�� �a�i rj TENANT.�ROVEMENT � ��; ��„��` ,���r
�ZII�D7NG,�3HEL��iDNLY?�,� �..n YE3 �NO��� ��� '�a � �BASIC PLAN? ,��`. �Y. ; �"` .,�n YE.Sr�,��o NO„r..3.,�� ��
ZQ11TIl�ti�}'DESICiNAT30N� �;�,�� F � �. � "�y� �`��� ',w� �CHANGEQF;ZTSE?�� ^� „�,�� ' ��,,� �
� �
NE�ADDRE3S '�� "�.�; ' � a YE3� n NO r
"diEgUlREIy�� �3 c�YE.4��11T0 ° � IJPJSEPA✓SITa� ��, ��,�. �o YE.9 ; ❑NO: � �� : _
.,.
PLATuTED"L01;?�,^�,.. ;.,�„ . ;:q YE3 ..;o,NO_.. ; 4..,�. . ,;� DEbiO PERMIT RE91JIItED7: g =o'YE3,;' ❑NO.;. y�� ��
� _n,_,.. �
Bulletin#100—January 7,2005 Page 2 of 4 k�Handouts�Pernrit Application