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08-102752t CnY OF I 4 F d al Wa O'l - LQ- 2 a 5,2, e er y ,��+ RMIT COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE EN P 33325 D AVENUE SOUTH • 63971 9718 rI N 0 PLI CATI ON FEDERAL WAY, WA 980639718 �/v 253- 835 -2607• FAX 835 -2609 The following is uir'd Inb jM - an incomplete application will not be accepted. Please print legibly (in ink) or type. PROPERTY INFORMATION SITE ADDRESS 3 (L Q © S- Y-1944" S+ C e e { re j e U W ,? u 70 0 () l SUITE /UNIT # ASSESSOR'S TAX /PARCEL # -7 J Zg - - � h LOT SIZE (sfi LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) L 13 h R Ett, I+A � U 12 V r� �.{ WI, V' -fSTy (Attach separate page for leaythy legd descri W TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING K FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included n this permit onlul r S, \ I-e. 5 �r►a s Sy�Fs w u,4 ; e S 1 ; v� I Q C,,_C4 -11v1 � &LtLN1A.5JA� -11i'P heA—) L-G,+ --,1+v Y-e-v Otb . SS� �1%r�Vl �ecL 1,0, � PROJECT NAME (Name of Business or Owner Last Name) L5 PROPERTY OWNER CONTRACTOR APPLICANT PROJECT CONTACT LENDER NAME PRIMARY PHONE MAILING ADDRESS c, werl -.av, e Floor CITY, STATE. ZIP (y p) ©OKbrDak- Cermce. TL E -MAIL ADDRESS COMP NAME Srn '`r APPLIC T NAM r4 OFFICE PHONE 926 !a MAILING ADDRES 1( 01. -54� CITY, S . ZIP w?f- 98S1/2-t/ CELL PHONE ( ) - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DA 1 L? - 000055 -0c) /a /3/ ) FAX NUMBER ( ) CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE SM17r"FSQ�6 ()T 11 /Z /0 `r E -MAIL ADDRESS COMP NAMErn i APPLICANT NAME e 111k- OFFICE PHONE MAILING ADDRESS r• 1 Lo 6 -- s 4 1^ CITY, STATE, ZIP -,�- 0.0 0YVk W CELL PHONE ( ) RELATIONSHIP TO PROJECT ❑ Architect ❑ Tenant ❑ Agent KOther k t0 Q p FAX NUMBER ( ) - NAMP n A, V Q \ V \.w— PRIMARY ( Lam) PHONE Zl 2 95 ( '(• C Y`SeSt%Ii NAME Per RCW 19.27.095: Lender information is required if project value exceeds $5,000 MAILING ADDRESS CITY, STATE, ZIP /PHONE l ) EXISTING USE �� 111 YVI&rC+ k PROPOSED USE D nA M. "i C t Q EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $ I I L 7. D a SPRINKLERED BUILDING? YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? 4 YES ❑ NO WATER SERVICE PROVIDER T LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC) . Cu1M l AREA DESCRIPTION EXISTING S . FT. PROPOSED S . FT. TOTAL S . FT. BASEMENT GAS WATER HEATERS MISC (Describe) BOILERS FIREPLACE INSERTS FIRST COMPRESSORS FURNACES RANGES SECOND GAS LOG SETS REFRIG. SYSTEMS HOSE BIBBS THIRD FOR,OFFICE USE OIVI.Y ADDITIONAL FLOORS (DESCRIBE) ❑ NEW o ADDITION DECK (❑ COVERED OR ❑ UNCOVERED ?) o REPAIR o TENANT IMPROVEMENT BUILDING SHELL ONLY? GARAGE ❑ CARPORT ❑ BASIC PLAN? o YES o NO NUMBER OF FLOORS E7CISTII76 PROPOSED tOTAL TOTAL ETC97WO SF TOTAL PROPOSED SF TOTAL SF * *NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ N FIXTURES Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION) AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES BBQS FANS GAS WATER HEATERS MISC (Describe) BOILERS FIREPLACE INSERTS HOODS icummo -w) COMPRESSORS FURNACES RANGES DUCTS GAS LOG SETS REFRIG. SYSTEMS PLUMBING CA #I 2 S 2 +ew S DATE BATHTUBS (or Tub /Sbo —r Combo) LAVS (sammomSb,k:i URINALS MISC (Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS rroucq ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBBS SUMPS FOR,OFFICE USE OIVI.Y I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the best of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the issuance of this permit does not remove the owner's responsibility for compliance with local, state, orfederal laws regulating construction or environmental laws. Ifurther 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, 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. Bulletin #100 - January 1, 2008 Page 2 of 4 klHandouts\Permit Application CA #I 2 S 2 +ew S DATE SIGNATURE: ^k Il l t v ,rite) Property Owner and /or Authorized Agent FOR,OFFICE USE OIVI.Y ❑ NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT BUILDING SHELL ONLY? o YES c NO BASIC PLAN? o YES o NO ZONING DESIGNATION CHANGE OF USE? o YES o NO NEW ADDRESS REQUIRED? o YES o NO UP /SEPA /SU. o YES o NO PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? DYES o NO Bulletin #100 - January 1, 2008 Page 2 of 4 klHandouts\Permit Application