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06-103326pro RECEIV Federal Way PERMIT commuM7YDEv PmR!; w1c L 0 6 2Q06 339ZS8WAUWA ,WA 9•PO971 931 ��pLICATIO N FEDERAL WAY, WA 98t1G7 -9718 ssssss- s6o7•FAxas3as OF FEDERAL wrumdtvoli'ederalwcy BUILDING DEPT. The following is - an • L - --: SF MF CO ME EL PL DE will not be accepted. Please or SITE ADDRESS .� 15� h 4� S ('�; 5 0 -2-- ? L SUITE /UNIT i — ASSESSOR'S TAX /PARCEL # 4 (0 �Z ©- v D j_ LOT SIZE (s� LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) t r -G (Alto- %aepa-tePmjefa ykg&darotWaq PROJECT • • TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this oennit only) PROJECT NAME (Name of Business or Owner Last Name) PROPERTY OWNER CONTRACTOR APPLICANT CONTACT LENDER NAME V � '(-� t Y v t, l-\ (% 4�i) b �� - U✓ b PRIMARY PHONE - - MAILING ADDRES�Sq CITY, TE, ZIP �V`.�`+�dti COMPANY NAME APPLICANT NAME OFFICE PHONE o r4 to MAILING ADDRESS „ CITY, STATE, ZIP CELL PHONE CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE L-B' FAX NUMBER L CONTRACTORS REOISTRATION NUMBER (copy of card required with each application) EXPIRATION DATE v�K� r7gb Zl_Z COM AME Cz APPLICANT NAME OFFICE PHON ( ) _ MAILING ADDRESS CITY, STATE, ZIP CELL PHONE RELATIONSHIP TO PROJECT ❑ Architect ❑ Tenant ❑ Agent o Other (Describe) FAX NUMBER NAME PRIMARY PHONE E MAIL ADDRESS 1S 3 3 'l i - "J° �l �.. ,r:j { / Ak: i'.�: vX Y.Y-ii ( 4f Y^44Y;:•Y�i ��;.3 A °� € eF .i;�r ..I .f,C �•ii i C-�: d.�Ci d %�;'��;.!�!a; EXISTING USE PROPOSED USE EXISTING ASSESSED /APPRAISED VALUE ($ VALUE OF PROPOSED WORK �- SPRINKLERED BUILDING? o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? o YES o NO WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE O TACOMA o PRIVATE (WELL) SEWER SERVICE PROVIDER O LAKEHAVEN 0 HIGHLINE ❑ PRIVATE (SEPTIC) AREA DESCRIPTION EXISTING PROPOSED TOTAL BASEMENT S . FT. S . FT. S . FT. FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS (DESCRIBE) DECK (COVERED ?) GARAGE 0 CARPORT O NUMBER OF FLOORS cusraro rsorww TOTAL "NEWHOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. Value of Mechanical Work $ _ AIR HANDLING UNITS _ BBQS _ BOILERS COMPRESSORS DUCTS PLUMBING BATHTUBS (or Tub /Shower Combo( DISHWASHERS GAS PIPE OUTLETS WASHING MACHINES LAVS (Bohm-81W.4 EVAPORATIVE a„hm- EVAPORATIVE COOLERS FANS FIREPLACE INSERTS FURNACES OAS PIPE OUTLETS SHOWERS SINKS SUMPS URINALS VACUUM BREAKERS GAS LOGS REFRIG. SYSTEMS HOODS (Commercial) WOODSTOVES RANGES MISC (Describe) GAS WATER HEATERS WATER CLOSETS (loileq MISC (Describe) DRINKING FOUNTAINS RAINWATER SYST HOSE BIBBS ELECTRIC WATER HEATERS I cert{jy under penalty of perjury that the Wormation 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 RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent .4 Contractor ❑ Architect ❑ Other Bulletin #100 — January T, 2005 Page 2 of 4 MIHandout Mermit Application