06-105771 � � RES��M�TTED
cm oF�/�M� " O � Q � — � O ���L
Federal Way N0v � IT
COMMUNfIYDEVEIAPMENf SERVICES L u� SF MF CO ME EL PL DE EN�
333258TMAVEMIESOUfN•POBOX9718 �'+I'� OF��(����.CATI ON
FEDERAL WAY.WA 980&?-9718 V ���u , / /
253-835-2607•FAX'153-835-2609
u�ii�u.�Nol federa(u�au.wrn
The ollowin is r uired injormation-an incom lete a licaHon will not be acc ted. Please rint le ibly(in ink)or
. � . � . �
SITE ADDRESS �I �� D L�� J'�V e . S. ��•w"'"" 1 `o W 3 SUITE/[JNIT#
ASSESSOR'S TAX/PARCEL# V � L � � - `� D �� LOT SIZE(s�
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
Uuro�rt��re�e fa��yun��y�aes�rmN
• • • • •
TYPE OF PERMIT ❑BUII.DING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL O ENGINEERING �FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Prouide detailed description of work included on this permit onlu)
I v�5tzc,e�2, �-F c�►-�S� �.I D'J�. �'r� Sv�-r�,�v�e 5�-►'ov�_ 5/,N���-v�/J � a'ti h�t�t" ����,
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PROJECT NAME(Name of Business or Owner Last Name) �Y�C�i Yl�l 1�����l:l�jey 11 Y i � �
.
• � • • •
PROPERTY N�E �- �%ti�✓Wv�-i � I/`�`./ (RtmnaYPHONE
OWNER v� �V1�� j -
MAQ.ING ADDRESS CTTY STATE,ZIP
�, � r�. g,r�..v�d�f. ��`�tanr C�1.��1`�-2 C� �1(a-n�
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
�i vn ZXGvi n�e,i I I!�(-1.�,�� o�R�a�r c2o(���t I - ��-bb
�5aa�i�� I-k� �.� oU �e,a�t�� w�q$l� ���N�i - �
CT1Y OF FEDERAL WAY BUSINESS LICENSE MBER D D EXPIRAITON DA1E FAX NUMBER
i'�-�.9- 1 d � $ � �-B L �2� 3 i �o �2�1P�2�I - (�i oa
CONIRACI'OR'S REGISTRAI'fON NUMBER(copy of card reqnlred with each appLLcatloa) EXPIRA770N DA7E
r 5 1 M � L � � �ISg � C� b � / Ia. �D�
� APPLICANT COMPANY NAME APPLICANI'NAME OFFICE PHONE �j
+. �i�M- ��`l�1 yl�V�. ��. V' ,.Q_(�,� ��i�,!) ��� - 1`Tll�D
MAII.ING ADDF2ESS C STATE,ZIP O CELL PHONE
�52.0 l�'� �� S.�"��0 �-e(.itF'(x W� a��� ( ) -
REIA770NSHIP TO PRWECT � ,��,,�y FAX NUMBER/�
❑Architect ❑Tenant �'Agent �ther(Describe);J�b �I�wU (��p) Z"[� - ��(J`D
CONTACT N E L)� PRIMARY PHONE E-MAIL ADDRESS
afh� (�'Rf.Gir�or c,"�`�r�`�.��.P ( ) 2,.�1 r - 1�L��' �.or�ea�� c.�;w1-,
LENDER �r " NAME
�5�a� � ��+p����� �� ���
� ��� � ��� ,����%
MAILING ADDRESS � �� CITY.STATE,ZIP PHONE
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� � : 1 • • •
EXISTING USE N'Q.�� 1�� PROPOSED USE I��I N�J"uW��
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ ����> ��
3PRINKLERED BUII.DIIHG? �YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REgUIRED? ,J�YES o NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHI.INE ❑ TACOMA o PRIVATE(�VELL) ���l.+�j(,-�(�
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLIIVE ❑ PRIVATE(SEPTIC) P WQ�L�Cj
• • .. •
AREA DESCRIPTION EXI3TII�iG PROPOSED TOTAL
S .FT. S .FT. S .FT.
BASEMENT � �
FIRST �y,� *�,
l l�f�
SECOND �'�
�rxi� N J A
Foux� N ��
ADDI1'IONAL FLOORS(DESCRIBE) � }(�
I"l
DECK(COVERED?) � j A
� �-r
GARAGE ❑ CARPORT❑ A 1� /\_
�v l—�
ax�sram moeoasn ivr.w :,+ro1'eLltlCisT�fa4 e1r;h� r .TD1et�ntoxflem '�o'�iDA e1M
NUMBER OF FLOORS � . � �— .�'� �� i � ���`. �,�/
' ?. .. �
"•NEW HOMES ONLY•• NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ . I �7$
Indicate number of each type offixhire to be fnstailed or relocated as part of thts project. Do not include existing ffxlures to remain.
MECH[11VICAL � y
Value of Mechanical Work $ ���
AIR EfANDLING UN1TS EVAPORATNE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS�commemtap WOODSI'OVES
BOILERS FIREPLACE INSEIrTS I2ANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUCLETS
PLUMBWG
BATHT'UBS�orltib/showercomeo) SHOWERS WATERCLOSEI'S[rourU MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNCAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Betn�oo�,s+r�s) VACWM BREAKERS ELECTRIC WATER HEATERS
� •
I certify under penalty oJperfury that the information furnished by me is true and correct to the best of mg kno�uledge,and further, that I
am authoriud by the owner oJ the aboue premises to perjorm the uwrk for�uhtch the permtt application is made. I further agree to hoLd
harmless the City of Federal Way as to any ciaim(tncludi�q costs, expenses, and attorneys'fees{ncurred tn the invesrigation and defense of
such cla{rrp,which may be made by any person,{ncluding the undersigned,and filed against the City of Federal Way,but only�uhere such claim
arises out of the reliartce oJ the city,including its officers and emp(oyees,upon the accuracy of the{nformation supp[ied to the city as a part of
this application.
NAME/TITL� �����'^4���-��'��� DATE �� 'Z�•0 b
�Signature) (Title)
RELATION3IiIP TO PRWECT ❑ Owner C9�Agent t�ontractor ❑ Architect PfOther Sv-b�-C�r�'�T`��
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Bulletin#100-]anuary 1,2006 Page 2 of 4 k\Handouts�Permit Application