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07-100121-"" ~'"~,-, • <lrTOF ~ ~t:-c 0 -1--_1_ o a L 2:-h co,t:!:::!!:!~c~ "\ \ ~ '2.~~7 PERMIT SF MF CO ME EL PL DE EN{!v ;133251/fflAVE:NUSSOl!l'H ·l'OCIOXJ/7 ~," ~LICATioN r 1 Fl,Df:RAI. \VAY. ll'A fJSOIJ:),9718 ' I I 2s.,.s:i5,2607• ~l'IX 253-835-!1609 'io?.e. 0 ... ,,.,,.,.;,,,,,11.,ac ·ei·cpu ,,,m ~,n.Qt~\~G. O~r • Thefotlawi.ng is reqt i~~lnformation -an incomplete application will not be accept.ed. Please pri.nt legibly (in i.nk} or type. • PROPERTY [NFORMATION SITEADDRESS _·_2.._\_0 _:-"\_;___~_._3_2....;;;0~~---=s=-~..,.--'--e.e;._t" _________ _ 1-L_ L 2__ d_ _a_ -Q_ ..Q _I Q_ ASSESSOR'S TAX/PARCEL II SUITE/UNIT# ----- LOT SIZE (sj) LEGAL DESCRIPT[ON (e.g. Acme Estates, Lot 1} _.Th~...:<a..-.,,,&,=.=..1'111.:..:.:...:..tn:....:..=o""'IJ."'"'5=--------------------- Wtcd> Ri!po,Gk, f'0!11'forle~""'1togaldsr.scripfon/ • PROJECT fNF'ORMATION TYPE OF PERMIT D BUILDING O PLUMBING D MECHANICAL 0 DEMOUTION D ELBCTRICAL O ENGINEBRJNG X FIRE PREVENTION SYSTEM PRO.JECT DESCRIPTION (Provide detailed description qf work in.duded on this permit onJuJ / \Y\. ~ kll Fir< A,lex.r"" ,·11 c, e,111..1 PV\.rt~ ~r e c,.,$. 01 'A• Or·,-, A "iJ /l ~/\.~-PROJECT NAME (Name of Business or Ouxter Last Nome) ---=--'--=-"""°'"-=--=~=c.......:..---=C:>=-:1"'-_"""_.....---= •!..>:;,.._ _____________ _ PROPERTY OWNER CONTRACTOR APPLICANT PROJECT CONTACT LENDER • PEOPLE !~FOR.I\L\TlO:\ CIIY. STATE. ZlP f:--eJ W e., w.A-~ S-00 .3 COMPANY NAME APPUCANT NAME \-1a..G ('.;oM 1---.J~ \-<.ns e.CJ I\ (\ -e,y-- MAILING ADDRESS eo 'E:.o'I 3q3;;i._ CTIY. STA'lE. ZIP q 812-4 S~TTL€. wA Cm' OF' l'EDEMI, WAY BUSINESS LtCE:NSE NUMBER EXl~RA110N DATE ·W ··o4-10 1 t'lr -oo -BL 12/3 , / 2.00, CON"IRAC1'0RS REClsmKOON NUMBER EXPIRATION DA1E \-1 1'2~ C ,-., L-''Vi?'3 t-J lC i \lq I z.oo ~ COMPANY NAME Al'PLJCANT NAM£ MAIUNO ADDRESS CTlY. STATF-. 7.JP RELATIONSHIP TO PROJECT D Architect oTenant oAgent o Other N'Z C (b !) /) ,e,.y-- PRIMI\RY PHONE r, 5, (~S3 ) f:.'1) -'301/o NI\ME Per RCW 19.27.095: PRIMARY P1·10NE ( ) OFFICE PHON!,; ( 2SJ ) 815 -20l(c C ELLPHONE -04-~.!J C 253 )~.1 FAX.NUMBER (Z.>1 )8,5 -107-5 &-MAILADDRESS 1-1 ('(.Lo m. r-J .,___J <i3 C,omu,sf-. i'l OFFICE PHONE { ) - CEl,L PHOlY"'R ( } - ~"AX NUM8.EK ( ) - I E-MAIL Af)ORESS ~,r-e. (0/1"\()v'\.l© WnlU.f Lender ll'lfonnation ls reqwred if project value exceeds $5,000 MAIJ .. !NG I\DDRESS CfJY. SfA'JE.. ZIP I (HONE } - EXISTING USE ----'1-"--+'----'~--------------PROPOSEDUSE --------------- EXISTING ASSESSED/APPRAISED VALUE $ _________ VAL1JEOll"PROPOSEDWORK $ 4k0 ,5 . OD SPRINKLERED BUILDING? ONO WATER SERVICE PROVIDER o LAEEIIAVEN SEWER SERVICE PROVIDER. o LAKEHAVEN PJRE SOPl'RESSIO.l'f SYS1'EII PROPOSED/REQUIRED? 'f<YES D NO D BIGBLil'fE D TACOMA D PRIVATE (WELL) D BJ'('..RJ,JJIB D PRIVATB (SBP'l'IC) ef • PROJECT FLOOR AREAS -------AREA DESCRIPTION EXISTING PROPOSED TOTAL so. FT. SQ.FT. SQ.FT. B ASEMENT FIRST SECOND TI-URD ADDITIONAL FLOORS (DESCRIBE) DECK (0 COVERED OR O UNCOVERED?) GA.RAGE 0 CARPORT 0 NUMBER OF FLOORS I E:llSflll'G I PROPOSED l '!OZ'Al. TO'J'.61...ED!J'l'IHG SP TOTALPRpFQ'i;l!DSI' TOrALSP .. 'NEW HOMES ONLY"• NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ • FIXTUR ES -------·----· --· Indicate number of each type of jlxture ln be Installed. or relocated as part of this prqject. Do n.ot include existing jlxtures to rema.ln. MECHANICAL Value of Mechanical Work $ (A COPY OF BID OR ESJ1MA1E MUST BE INCLUDED W1ffi APPUCATION) AJR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTL!n'S WOODSTOVES l:lBQS FANS GAS WATER HEATERS MISC [Describe) BOILERS FIREPLACE INSERTS HOOUS 1co""""1'CL,1J COMPRESSORS FURNACES RANGES DUCTS GASWGSETS REFRIG. SYSTEMS PLUMBING BATHTUBS lo1Tub/st,,,,,,:,Co.u!.l)()J wws (B,oll>room SJak<l URINALS MISC (Describe) DISHWASHERS RAINWATER SYST VACUUM BR£AKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS 1T0Ue1J ELECTRIC WATER tl£ATERS SINKS WASHING MACHINES HOSE BIBBS SU!l1PS S I GNATURE -------~·---------~------ l certify under p,ma1ty of perjUJ'Y thtl.t the U'l(omiatwn ftuT!ls.lwd. by me is ttue and corne,ct to the best of my knowledge, and .further, that I am authorhed by the oumer qf the abooe pf'<l!'fflises l:o pa;farrn the -,,.Jc far which the p«ml.t a,pplicarian is made. I .further agree to hold hannle.ss the city of Federal Way as to any daim (incwdlng costs. expenses. and atromegs• ftt.s in.cun-ed in tile tnvestigatlon and defense of such clabn}, which mqy be made bg any per-son, incl:udin9 the urlikt"5ign.ed, and.filed. against the City of Federal. was, but only where such claim arises out of the reliance of tile dlil, inclr.ullng Us o.lJfcer.$ and employees, upon the accuracy of tl'l.e iqfonnation supplied to the clty as a part qf this appUcation. } / / Z- NAME/TITLE /_~ f.12..o";J (}/fevt_ DATE I / Bf /?A::>o-'1 (SIJ:MlUIC) (1ltle) 1 RELATIONSHIP TO PROJECT [] Owner D Agent ~orru-actor o Architect D Other _____________ _ FOR OFFICE USE ONLY I oNEW o ADDITION o ALTERATION oREPAm o TENANT IMPROVEMENT BmLD.ING SHELL ONLY? oYES oNO BASIC PLAN? oYES oNO ZONING DESIGNAnON CHANGE OF USE? a YES oNO NEW ADDRESS REQUIRED? oYES o NO UP/SEPA/SU? oYES oNO PLATI'EO LOT? oYES oNO DEMO PERMIT REQUIRED? oYES oNO Bulletin #100 -January l, 2007 Page 2 of4 k\Handoucs\Pcnnit Application