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05-100357RE # i 4A ciTr of Federal way AN 2 7 2oo5PERMIT r� APPLICATION J,36,3o FIRST k:tYSOGTN • PO BO.\ q-ig FEDERAL WAY, WA g8o63•q-i,4 253.66i -vu- FAX: 253 -66t -4121) I&Uvx t1fGftrAtlGtty,CQM The following is required information - an incomplete annlication will not be accented. Please print legibly (in ink) or type. SITE ADDRESS: r5 ZGx" I SUITE /APT # ASSESSOR'S TAX /PARCEL #: 1 k Z 1 !�2r _4 - 1 d © I SQUARE FOOTAGE OF LOT: LEGAL DESCRIPTION (e.g.: Acme Estates, Lot 1) (Attach separate page for lengthy legal description) PROJECT INFORMATION TYPE OF PERMIT (This application): ❑ BUILDING O PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING SIRE PREVENTION SYSTEM PROJFWr DE CRIPTION,1PProvide detailed description of work included on this permit only): 153,7 f EW>E7j io AJEW 4r0qj?1b PROJECT NAME (Name of Business /Owner Last Name): Cy PEOPLE INFORMATION PROPERTY OWNER: CONTRACTOR: LENDER: cif P-p—d V.1- , a 5,000) APPLICANT: NAME: e PRIMARY PHONE: MAILING ADDRESS (STREET ADDRESS;): v CITY, S1:4TE, ZIP NAN E new IrE�'nnr�.� C P: \NY t� l t= �✓a.�`r' OI+ +ICE PH NE: (�S )4e� -�5� n 2i MAkLINQ ADDRESS � E t 1738 C U.C�IJI RJ✓l t l(.�� (rte) 7: - CI' Il' 01" FEDERALNVAY BUSINESS LICENSE, NUMBER: I- '- \PIRATI0NDA'I'I•:: FAN NUMBER: coyri ACrOR's REGISTRATION NUMBER: E.\ IRATION DA -IT.- (copy of card required with each application e ) Y / F> --I t3 � `-� NAME: ll: \ll1 >IEPHONE: - -� DIAU.ING ADDRESS (STREEIr ADDRr•_55;)". CI M STATE, Z1 -� - - -" NANIE: COMPANY OFFICE PHONE: - - - - "- " - -� MAIL G ADDR A DRESS): CITY, STATE, ZIP EVENING PHONE: --- _- " - - - -' REI.ATIONSTIII' TO PROJECI': ❑ Architect ❑ Tenant ❑ Other (Describe):_ FAX NUMBER: CONTACT PERSON FORTHIS PROJECT: ❑ Property Owner VCc1ntractor Applicant 1` `l \It \DUR �S: - - -� DETAILED BUILDING / ' EXISTING USE: EXISTING ASSESSED /APPRAISED VALUE PROPOSED USE: VALUE OF PROPOSED WORK: SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED ?: OYES ONO WATER SERVICE PROVIDER: O LAKEHAVEN ❑ HIGHLINE O TACOMA ❑ PRIVATE (WELL) SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC) AREA DESCRIPTION EXISTING SQ., FT. PROPOSED S . FT. TOTAL BASEMENT FANS HOODS (Commerc al) WOODSTOVES -5 FIRST FIREPLACE INSERTS RANGES y MISC (Describe) SECOND FURNACES GAS WATER HEATERS �lekz �z1AJu, E2 THIRD GAS PIPE OUTLETS ❑ YES o NO �C �•• FOURTH UP /SEPA /SU? o YES o NO _ ADDITIONAL FLOORS (DESCRIBE) SHOWERS WATER CLOSETS croi)eo MISC(Describe) DECK (COVERED ?) SINKS DRINKING FOUNTAINS GARAGE /CARPORT SUMPS RAINWATER SYS HOW MANY FLOORS? TOTM. EXISnNG TOTAL PROPOSED TOTM. E%ISnNG AND PROPOSED * "NEWHOMESONLY *" NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ ldicate number of each type of fixture that is to be installed or relocated as part of this project. Do not include existing fixtures to remain. NIECHANICAL 1 Value of Mechanical Work $ 7 �i AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG. SYSTEMS BBQS FANS HOODS (Commerc al) WOODSTOVES -5 BOILERS FIREPLACE INSERTS RANGES y MISC (Describe) COMPRESSORS FURNACES GAS WATER HEATERS �lekz �z1AJu, E2 DUCTS GAS PIPE OUTLETS ❑ YES o NO �C �•• PLUMBING UP /SEPA /SU? o YES o NO _ BKrKTUBS(WrublSb."'r'co.oW) SHOWERS WATER CLOSETS croi)eo MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYS WASHING MACHINES URINALS HOSE BIBBS IAVS (Bmh —no Sink VACUUM BREAKERS ELECTRIC WATER HEATERS I certify under penalty ofper jury that the informationfurnished by me is true and correct to the best of my knowledge, and further, that I ant authorized by the owner of the above premises to perform the ivorkfor which the permit application is made. 1 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, andfiled against (lie 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 t ' orrnation(supplied to the c' as apart of this �/appp�lication. NAME TITLE: i�ti- " C`' t0 .3. ' 1& C DATE: ( � RELA"I'IONSHIP TO PROIJECT: O Property Owner o Applicant contractor D Architect D FOR OFFICE USE ONLY: e NEW o ADDITION ❑ ALTERATION o REPAIR TENANT IMPROVEMENT BUILDING SHELL ONLY? ❑ YES a NO BASIC PLAN? o YES o NO ZONING DESIGNATION: CHANGE OF USE? ❑ YES o NO NEW ADDRESS REQUIRED? o YES ❑ NO UP /SEPA /SU? o YES o NO _ PLATTED LOT? o YES ❑ NO DEMO PERMIT REQUIRED? o YES o NO Bulletin # 100 -January 13, 2004 Page 2 of 4 kAHandouts - Revised\Permit Application