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06-105379CITY OF + J — Federal Way OCT 2 0 ?006 PERMIT COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE EN FP 3933E FEDERAL WAY. Wi1TEJ � OW119 lr )F FEDEFiAPPLICATION ro AfiDERAL WAY. WA 58aS3.8'RJ 253.635¢807•FAX253-s-v.260sBUILDING D luullu. �Offedemhunu.cnm ThefoIlowin is re wired fn armation - an incomplete application will not be accepted. Please iDrint Iegibly [in inkj or [ e. PROPERTY• • SITE ADDRESS53 �JU_ _ SUITE/UNIT # ASSESSOR'S TAX/PARCEL. # Z , Z a - D LOT SIZE (SO LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) ' 22- JAllach separale pagefw lengthy legal descripffon) TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL �� El DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING 4 FIREIREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu) APPOVLAs R())LM A)h FIP A-410.nr1. -,-' -'zMc yin V- .n5�.v IOFI� C. -(s(0 r: PROJECT NAME (Name of Business or Owner Last Name) PEOPLEI • • PROPERTY OWNER CONTRACTOR APPLICANT CONTACT LENDER EXISTING USE NAME PRIMARY PHONE �,e��n�_-� �- • rye ( ) - MAILING ADDRESS CITY, STATE, ZIP COMPANY NAME APPLICANT NAME OFFICE PHONE (C "pq p&25oa&ey0 MAILING ADDRESS P560 A-U AD • CITY, STATE, ZIP wcl33 CELL PHONE (ao�) �- OS CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER E IRATION DATE FAX NUMBER - -&- i Q S b - o - B L !a 1,51 / o6 I (.;l0b)3b8 - 3(73 CONTRACTOR'S REGISTRATION NUMBER Ieopp of card required with each application) EXPIRATION DATE 1 +� D S B a q/ (( / 0� COMPANY NAME APPLICANT NAME OFFICE PHONE PEP HIV L 1-� t L� ( v5 6 a - ki 6 I! MAILING ADDRESS CITY. STATE. ZiP CELL PHONE D 1-,fA)Kjw = A $� (fob) -�a RELATIONSHIP TO PROJECT ❑ Architect ElTenant ❑ Agent Other (Describe) (� ©IC�f� De FAX NUMBER (J Z ) �j6j`- - J NAME PRIMARY PHONE E-MAIL ADDRESS LYa-kj ( S )b' - (IbX 10 Fi Ysr Per ACW 13.27.095: Lender ir1formution is NAME required Vprojetrt value exceeds.$6,000 MAILING ADDRESS CITY, STATE, ZIP PHONE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ �S F 9. 0 0 SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC) f AREA DESCRIPTION I EXISTING _ SQ. FT. BASEMENT PROPOSED S . FT. TOTAL S . FT. FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS (DESCRIBE) DECK (COVERED?) GARAGE ❑ CARPORT ❑ NUMBER OF FLOORS —111T— PROPOSED TOTAL TOTAL EII —11 TOTAL FNOPOSEO BP TOTAL SF **NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE 8 Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing MECHANICAL Value of Mechanical Work $ AIR HANDLING UNITS BBQS BOILERS COMPRESSORS DUCTS BATHTUBS (or Rib/Shower Combo) DISHWASHERS GAS PIPE OUTLETS WASHING MACHINES LAVS (Bathroom Sinks) EVAPORATIVE COOLERS FANS FIREPLACE INSERTS FURNACES GAS PIPE OUTLETS SHOWERS SINKS SUMPS URINALS VACUUM BREAKERS GAS LOGS HOODS (comet—jsi) RANGES GAS WATER HEATERS WATER CLOSETS (Touet) — DRINKING FOUNTAINS RAINWATER SYST HOSE BIBBS ELECTRIC WATER HEATERS rttt2res to remain. REFRIG. SYSTEMS WOODSTOVES MISC (Describe) MISC (Describe) I certify under penalty of perjury that the b1formation 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, ineiwiing s officers d employe upon the accuracyZa information supplied to the city as a part of this application. NAME/TITLE DATE LJ Q Vgsaatur ('t)tle) RELATIONSHIP T CT, El Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other FOR OFFICE USE ONLY ❑ NEW ❑ ADDITION ❑ ALTERATION F- REPAIR ❑ TENANT IMPROVEMENT BUILDING SHELL ONLY? DYES ❑ NO BASIC PLAN? D YES ❑ NO ZONING DESIGNATION CHANGE OF USE? 0 YES ❑ NO NEW ADDRESS REQUIRED? ❑ YES ❑ NO TIP/SEPA/SU? ❑ YES ❑ NO PLATTED LOT? ❑ YES ❑ NO DEMO PERMIT REQUIRED? a YES ❑ NO Bulletin #100 — January 7, 2005 Page 2 of 4 k\Handouts\Permit Application