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04-103976C'11,0"' Pr S'CEI V Federal way PERMIT COAEDERALDEVELOPMENT SERVICEXPPLICATION 33530 FIRST WAY SOUTH • PO BOX 9718$ FEDERAL WAY, WA 98063 -9718 253- 661 -4115• FAX 253- 66] -"" www.cituo/J`ederalway.comCITY OF FEDERAL. WAIF BUILDING DEPT, T6a fnllnndnn is ronuirael infnrmnfinn — nn inammnlofa nnnlinnlinn "All n, SITE ADDRESS T'332N2L2 l ASSESSOR'S TAX /PARCEL # %�L - J-0 a j- 7 L SF MF CO ME EL PL DE E FP D / / oted. Please print leaibiu fin ink) or tune. SUITE /UNIT # LOT SIZE (sfl LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) ()M(1 .Q L4, 1'51- 0(00,P WO eLD V (S[O k) a ktCE (Attach separate page for lengthy legal d--c pHon) PROJECT 1 ' • TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL PM 2- /Tb em ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM PROJECT DESC PTION (Provide detailed description of work included on this permit onlul PROJECT NAME (Name of Business or Owner Last Name) ��.( U �C`d�(G PEOPLE •- • PROPERTY OWNER 1,2 B `$3 APPLICANT CONTACT LENDER NAME PRIMARY PHONE �7crsS e-5-Pb?-Vg r (aobl bS - 11411 MAILING ADDRESS CITY, STATE, ZIP o 50)%r 4449 MTL-2 WA 8 cad COMPANY NAME Q APPLICANT NAME /V APPLICANT NAME MAILING ADDRESS OFFICE PHONE � CELL PHONE M PAOLL 1 lUC (a06 ) 35s - 6 Zt �� ,� CELL PHONE =01-N MAILING ADDRESS CITY, STATE, ZIP as 3 GO rE LW 4p0'-1tcu FAX NUMBER - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE 4 04-3 0-1 Q 1 - B L % / (cR5 3) ffW - 45- CONTRACTOR'S (copy of card required with each application) EXPIRATION DATE =REGISTMBER -6-,2 6E C�? /tee /a5 COMPANY NAME �1 ee,20--/L /06) APPLICANT NAME /V OFFICE PHONE (Vvs) 6 y 7-- owl--6 MAILING ADDRESS CITY, STATE, ZIP CELL PHONE G© .D. S % n vtkJ /,t> 4M266 (a06 ) 35s - 6 RELATIONSHIP TO PROJECT Ffm FAX NUMBER ❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe). -40, 3 i� (1/9 S-) 6 NAME PRIMARY PHONE E -MAIL ADDRESS K � 6f7 - Q116 0- e-kPfsY os&-"s7 0.11: NAME MAILING ADDRESS CITY, STATE, ZIP EXISTING USE E/ PIR61 PROPOSED USE _ Q�� EXISTING ASSESSED /APPRAISED VALUE $1 _ VALUE OF PROPOSED WORK $ V �6 - 0 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 3 . FT. TOTAL BASEMENT FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS (DESCRIBE) DECK(COVERED ?) GARAGE /CARPORT HOW MANY FLOORS? * *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 EVAPORATIVE COOLERS GAS LOGS REFRIG. SYSTEMS BBQS FANS HOODS (commercial) WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC (Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS (or Tub /Sho—rCombo) 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 cert(y under penalty of perjury that the tnformation furnishdd 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. ,t If NAME /TITLE Z rte— . (- (� —1 (Signature) RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent (Title) ( Contractor ❑ Architect ❑ Othe Bulletin #100 - March 30, 2004 Page 2 of 4 k \Handouts — Revised\Permit Application