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05-100904Federal a Way PERMITF�y F co (E6 6 COMMUATIYDEVELOPME1rrsERVICES PL DE tP 33325 8 EF4L AY, WA 8063 971 9718 A p p L I C AT I O 2 20 FEDERAL WAY, FAX 98063 -9718 D 253 -835 -2607• FAX 25335.2609 www.ntuo({ederdwaymm CIT y OF FEpERq The following is required information —an incomplete application 944Q, .�q _ r 1Y Please print Legibly (in ink) or tune. SITE ADDRESS L_';� 1�� h` (jam �� SUITE /UNIT # �y �v¢3( ASSESSOR'S TAX /PARCEL M (D D t o � - � -/- 9 LOT SIZE (sj) LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) (Anarh reparate page for lemfhg legal desnlphbn) PROJECT • • TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL /� /�(� ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERD3(3c 91 FIRE PREVENTION SYSTEM �ESC�TI9N (ProvLde detailed desSri ton of work included orllthis permit onlul�___ ` 0 A PROJECT NAME (Name of Business or Owner Last Name) PEOPLE 1 PROPERTY OWNER CONTRACTOR APPLICANT CONTACT LENDER NAME cal PRIMARY PHONE OFFICE PHONE (yz')F7YZ. VWb MAILING ADDR j5-1 c)'3 - W c � MAIL­___ $ES9� 33 CELL PHONE 1 1 17 7,3 - Uy,STATE,ZIP, IP COMPANY NAME U S APPLICAkRWLE o� �: �!�fi OFFICE PHONE (yz')F7YZ. VWb MAILING ADDR j5-1 c)'3 - W C STATE, ZIP �d g' D CELL PHONE 1 1 17 7,3 - o /eld CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER PIRATION 'o -0 —L © 2-3 16 —B L ► /31 DATE /�� FAX NUMBER c�z5�7yt� -231 CONTRACTORS REGISTRATION NUMBER (copy of card required with each application( �-0 E_ Ra - F. so EXPIRATION DATE /q5" �/ '5-/6 COMPANY NAME APPLICANT NAME OFFICE PHONE MAILING-ADDRESS CITY, STATE, ZIP — CELL PHONE RELATIONSHIP TO PROJECT FAX NUMBER o Architect O Tenant ❑ Agent ❑ Other (Describe) ( - EXISTING USE PROPOSED USE EXISTING ASSESSED /APPRAISED VALUE $ 4, r o O VALUE OF PROPOSED WORK $ SPRINKLERED BUILDING? K YES ONO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? o YES $ NO WATER SERVICE PROVIDER ja- VAKEHAVEN D HIGHLINE O TACOMA ❑ PRIVATE (WELL) SEWER SERVICE PROVIDER VEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC) PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING S . FT. PROPOSED S . FT. TOTAL S . FT. BASEMENT FANS HOODS ic..m iml WOODSTOVES FIRST FIREPLACE INSERTS RANGES MISC (Describe( SECOND FURNACES GAS WATER HEATERS THIRD GAS PIPE OUTLETS FOURTH ADDITIONAL FLOORS (DESCRIBE) DECK (COVERED ?) GARAGE ❑ CARPORT ❑ NUMBER OF FLOORS &°1XO rsorosco rorw rorv.,tsrmaar _ rotacrcorossoar ,*Yonu sr "NEW HOMES ONLY " NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ 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 EVAPORATIVE COOLERS GAS LOGS REFRIG. SYSTEMS BBQS FANS HOODS ic..m iml WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC (Describe( COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS BATHTUBS (or Tub/Shoa<rrombnl SHOWERS WATER CLOSETS (toiky MISC (Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS laaoevom Slob) VACUUM BREAKERS ELECTRIC WATER HEATERS I cert(fy 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 harmtess 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 A AA AA DATE igna 1 (Title) RELATIONSHIP TO PR JECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Bulletin # 100 — January 7, 2005 Page 2 of 4 k\Handouts\Pelmit Application