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04-104340Federal Way PERMIT COMMUNITY DEVELOPMENT SERVICES 33253-661-4115- 30 FIRST AY FAX 53_PoBo'� � 2 1 "' A P PLI CATI O N FEDERAL WAY, WA 98063 -971 www.cituoffederalwat,,ftY OF FEDERAL WAY The following is r1-"4gi{�i %AWttdn - an incomolete aooiication will not be SITE ADDRESS I S} way 5vut11 y✓ r, •V ASSESSOR'S TAX /PARCEL # 9 LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) - j _D _q _3_q 4 SF MF CO ME EL PL DE E P F Ia /o/ l.-Wty ted. Please orint leaMm (in inkJ or tupe. _ (" S- - v_ U 1 5 p s m (Attach separate page far lengthy legal descriptiara SUITE /UNIT # LOT SIZE (sf x.53 AL TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL i ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ly FIRE PREVENTION SYSTEM PROJECT DESCRIPION (Provide Lf15j?c�� VnVGi�d-cTJI�G``detailed description of work included on this Permit onlul T"' -e,rv— )ine, arrl `/�' %isC ):/p - 4b r)c-,j � bud PROJECT NAME (Name of Business or Owner Last Name) �dCp�GWOCX�( y► 1 ce- 13ul U n j• PROPERTY OWNER CONTRACTOR APPLICANT CONTACT LENDER EXISTING USE h NAME � PRIMARY PHONE �ovr Vt -tntJrz-S Tn c. I poG ) �DQ3 -95-W MAILING ADDRESS j� j� !� 1/�/�� /,CCIIITY, STATE, ZIP J /� /yam j�/�/�(� Sao - 16Th ALA N 5L 1 c- /W •. eAvur- VV /'1 / U / COMPANY NAME L i,. d Gn +e r l' � � APPLICANT NAME ske i3^,A OFFICE PHONE (as 3) $7711 - &9-) zp� , � . -Nif- I" ,An ❑ Architect ❑ Tenant ❑ Agent iXOther (Describe) ( ) - MAILING ADDRESS CITY, STATE, ZIP CELL PHONE CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER - o C�- ©_ a ' 3 T - a / 31 /=q (?53) �3? -6IU3 _� B L CONTRACTORS REGISTRATION NUMBER (copy of card required with each application) EXPIRATION DATE LL o \LfJi a3 8013 1@005 COMPANY NAME 5,,rne, a.3 cOiltCrwC -40 - APPLICANT NAME OFFICE PHONE ( ) - MAILING ADDRESS CITY, STATE, ZIP CELL PHONE RELATIONSHIP TO PROJECT FAX NUMBER ❑ Architect ❑ Tenant ❑ Agent iXOther (Describe) ( ) - NAME ('� PRIMARY PHONE E -MAIL ADDRESS 54f-\)C- 130-vMz&r\ a53 8711 - 66A;a P!r1C I9f�d`l 96:' l arisriFr',ira�Ortliaan is a, , NAME tre.G I nOMt. S / a�c� MAILING ADDRESS CC)) Co) U ry o1 5 `f 5,, 0, 2000 CITY, STATE, ZIP LUr 99101 -?3Q4 PROPOSED USE EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $ -7 / 3SO p0 SPRINKLERED BUILDING? RYES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? )(YES ❑ NO WATER SERVICE PROVIDER �(LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL( SEWER SERVICE PROVIDER P( LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC( Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to MECHANICAL - Value of Mechanical Work $ AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG. SYSTEMS BBQS FANS HOODS {commercial( WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC (Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS (or Tub /Shower combo( SHOWERS WATER CLOSETS (Toilet' MISC (Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS Bathroom Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I am authorised 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 clairN, 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, including its officers and employees, upon the accuracy of the information supplied to the city as a part of this application. n NAME /TITLE ' �/i r L (Signature( RELATIONSHIP TO PROJECT []Owner ❑ Agent .('Contractor I ♦ uro' ❑ Architect ❑ Other l0 /2, / zooe-/ Bulletin #100 -March 30, 2004 Page 2 of k\Ilandouts -Revised\Permit Application