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06-103036
GEC E I VE� $,�b CITY OF �� 1 V 2006 I V S1 Feder�a�wa PERMIT — CovwallYnEvacoPI�icssF FEDERAL WatA SF MF CO ME EL 4L DE EN FP 3332S 8M AVENUE SOUTH • PO B*0kk D LNG D Eff FEDERAL WAY, WA. 98063-9718. APPLICATION 253 - 835 -2607• FAX 253 - 835.2- 835.2 609 www.dtyof den*mu.mm The following is required information - an inLo_nwkj"qq1ication will not 6e accepted. Please rant legibly in I& or ty . PROPERTY •- • SITE ADDRESS Q SO, 14'T" 5-T WA WaD3 SUITE /UNIT #k . ASSESSOR'S TAX /PARCEL #1 0 2 ( 3 LOT SIZE (s]) LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) (Attach a W—t a papa jar to V ft Ingot der W.Q PROJECT • • TYPE OF PERMIT ❑BUILDING UMBING ❑ MECHANICAL ❑ DEMOLITION ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM PROJECT. DESCRIPTION (Provide detailed description of uwork included on this permit only) IUST��G A PROJECT NAME (Name of Business or Owner Last Name) r tS KC-41 i ) OWNER CONTRACTOR APPLICANT CONTACT LENDER EXISTING USE NAME ©r , e �/� PRIMARY PHONE - L4 ' T � 1 ) i1 MAILING ADDRESS CITY, STATE, ZIP '1 2/5- 6 50 1 4h St er wo IVA t �3 COMPANY NAME i� APPLICANT NAME OFFICE PHONE T MAILING ADDRESS N-3 - -- - MAILING ADDRESS CO, STATE, ZIP aQ ^ ` CELL PHONE - RELATIONSHIP TO PROJECT ^ CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER ff -1 Q o Q$ oT V L. izl 3 j lib (jS3) - CONTRACTOR'S REGISTRATION NUMBER (copy of card required with e}ch application) EXPIRATION DATE COMPANY NAME APPLICANT NAME OFFICE PHONE ' a MAILING ADDRESS CrN, STATE- , ZIP CELL PHONE" RELATIONSHIP TO PROJECT FAX NUMBER ❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe) EXISTING ASSESSED /APPRAISED VALUE PROPOSED USE VALUE OF PROPOSED WORK SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED %REQUIRED? ❑ YES ❑ NO WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN . ❑ HIGHLINE ❑ PRIVATE (SEPTIC) 0 0 PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING S . FT. PROPOSED S . FT. TOTAL S . FT. BASEMENT FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS (DESCRIBE) DECK (COVERED ?) GARAGE ❑ CARPORT ❑ NUMBER OF FLOORS saaSTING nt torAr. "NEWHOMES ONLY" NUMBER OF BEDROer6S ESTIMATED SELLING PRICE $ number of each type of fixture to be installed or relocated as part of this project. Do not include existing Value of Mechanical Work AIR HANDLING UNITS BBQS BOILERS COMPRESSORS DUCTS t5ATH1'Uk35 (or Tub /Shower Combo) DISHWASHERS GAS PIPE OUTLETS WASHING MACHINES LAVS (Bathroom Sinks) EVAPORATIVE COOLERS FANS FIREPLACE INSERTS FURNACES GAS PIPE OUTLETS GAS LOGS HOODS (Commercial) RANGES GAS WATER HEATERS to REFRIG. SYSTEMS WOODSTOVES MISC (Describe) SHOWERS WATER CLOSETS Qoiieq MISC (Describe) 'A SINKS DRINKING FOUNTAINS SUMPS RAINWATER SYST URINALS HOSE BIBBS 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 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, including its officers and employees, upon the accuracy of the information supplied to the city as a part of this application. NAME /TITLE G ti NOW (Signature) ` ' (Title) TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other r__..__. l 11nn1C U-1 -,rA A—N-6—