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06-106094'A' 'CITY OF RECEIVE* Federal way PERMIT COMM UwY .` y°V� `aOer M`Ew E 33325 8'NENUE SOUTH PO BOX 974 0 y 3 V 2 FEDERAL WAY. WA 98063 -9718 253 - 835 -2607• FAX 253 - 835 -2609 XPPLICATION ollY OF FEDERALWA1t Byol vG DEPT. Tho fnllnmina is roomm rn nrmntinn - nn incnrr,nlolo nnnlwnfinn mill n, SITE ADDRESS l q Cq S. 34�Ti STr "J ASSESSOR'S TAX /PARCEL # ? `T - --C) -j- V LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) (Attach separate page for lengthy legal descrtptbrd PROJECT • • I SF MF CO ME EL PL DE EN (DF'P' 1D , ud. Please print leoiblu riot ink) or tune. TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL SUITE /UNIT # D102- LOT SIZE (s, fl ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING K FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this permit only) /n1ST -%K(4-T1--) Of' AA) AJ901 T1 wJ T-Z5 Al eX 1S i �1)(j 4;/;,r- � cSy��i►'l PROJECT NAME (Name of Business or Owner Last Name) MASS/1 -4 ro 6- PEOPLE • • PROPERTY OWNER CONTRACTOR APPLICANT CONTACT LENDER EXISTING USE NAME CPQS dw t- t_(- PRIMARY PHONE (9zs )qS3 - 4100 MAILING ADDRESS /s- /871", AiY SF Svir;'- 60 CRY, STATE, ZIP :,.,.4 cjdC�SS COMPANY NAME I�Ac,t F: c ti=p 1, S iE C,4 . APPLICANT NAME --r, " 667 -1WRrj OFFICE PHONE (24)(-) -798 - 3$ MAILING ADDRESS 640 06PLAIL PAC - 5 . CITY, STATE, ZIP S t ,,t rnL. CtA XryY CELL PHONE ( ) - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE Z Q - Q-2- -1 © 514 -q 7 - B L / / FAX NUMBER (Tai ) 7 2 b CONTRACTOR'S REGISTRATION NUMBER (copy of card required with each application) EXPIRATION DATE 10 130 6 7 COMPANY NAME ( ACIF—LC. �n4e, � S�ez�'z, 6,;(- APPLICANT NAME ��) CASTMA�/ OFFICE PHONE (zt�(v) ?$�l - 3$x(0 MAILING ADDRESS 8Z6 AWL" Sw-q� CITY, STATE, ZIP 5-c-ATTt 5/ CELL PHONE ( ) - RELATIONSHIP TQ PROJECT ❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe) C r •/b RIAC -TZ"� FAX NUMBER -7Z(A NAME err► �l�7- .�,�A� PRIMARY PHONE (0C(,) 7n - 3$a(0 E-MAIL ADD r1,E'. o Prs. a jW-00W 9. "f( U9 f itY:iRilt onl is 1ttrs d pr'ect uslerezz to �,(!O(#'` NAME MAILING ADDRESS CITY, STATE, ZIP PHONE EXISTING ASSESSED /APPRAISED VALUE PROPOSED USE VALUE OF PROPOSED WORK $ ��•� SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC) AREA DESCRIPTION EXISTING S . FT. PROPOSED S . FT. TOTAL 3 . FT. BASEMENT FIRST EVAPORATIVE COOLERS GAS LOGS REFRIG. SYSTEMS SECOND FANS HOODS (commesial) WOODSTOVES THIRD FIREPLACE INSERTS RANGES MISC (Describe) FOURTH FURNACES GAS WATER HEATERS ADDITIONAL FLOORS (DESCRIBE) GAS PIPE OUTLETS DECK(COVERED ?) GARAGE ❑ CARPORT ❑ SHOWERS WATER CLOSETS (Toilet) MISC (Describe) NUMBER OF FLOORS EXISTM MOPOSED TOTAL "TAL MINTING 0 TOTAL eROPOND W toret ar * *NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ Indicate number of each type off fixture to be installed or relocated as part of this project Do not include existing fixtures to remain. MECHANICAL Value of Mechanical Work $ AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG. SYSTEMS BBQS FANS HOODS (commesial) WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC (Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLVAEMG BATHTUBS (or Tub /shower combo) SHOWERS WATER CLOSETS (Toilet) MISC (Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS (Bathroom Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS I certiN under penalty of perjury that the ii} formation furnished by me is true and correct to the best of my knowledge, and further, that I am authorized by the owner of the abo premises to perform the work for which the permit application is made. I further agree to hold harmless the City of Federal Way to,7ny claim (including costs, expenses, and attorneys'fees incurred in the investigation and defense of such claim), which may be made Ian erson, including the undersigned, and filed against the City of Federal Way, but only where such claim arises out of the re a of the /'9� } uding its officers and employees, upon the accuracy of the Wormation supplied to the city as a part of this aoolicatio /'�Y / !1 f NAME /TITLE I RELATIONSHIP TO ✓ — ('Title) ❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Z >( -04:7 Bulletin #100 —January 1, 2006 Page 2 of 4 MlfandoutsTemiit Application