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08-105876 Oe _ l © 6-8 Fe'deranivaRECE ) [PERMIT SF MF CO ME EL PL DE EN FP COMMUNITY DEVELOPMENT SERVICES 33325 8n1 AVENUE SOUTH•PO BOX 9718 ?33-35-262 FAX 2531-733a9;6089 DEC 1 2 2o i PP LI C AT I O N / / w[ow.atwifede,nlumu.com E The followiG gWdFfe RA E.aWAynpiete application will not be accepted. Please print legibly(in ink)or type. • PROPERTY INFORMATION S I T E ADDRESS 3,..5-9V V d /I/ A . /.� /'S.6„)„ SUITE/UNIT i ASSESSOR'S TAX/PARCEL# 3 0 2 I J v - cr v 02._ LOT SIZE(sf LEGAL DESCRIPTION(e.g.Acme Estates,Lot I) CL,-:0c -Thi dekalesrp4 C4N.0 (Attach laParate awRrv+kcal • PROJECT INFORMATION TYPE OF PERMIT ❑BUILDING ❑ PLUMBING ❑ MECHANICAL • ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) -7s4-li pu//—sue--1-,,,,�5 �-� 0.,4 <, • I / PROJECT NAME(Name of Business or Owner Last Name) A A A . -4 LIB e II PEOPLE INFORMATION • PROPERTY NAME , PRIMARY PHONE OWNER e no k A ' • ( ) - . IL MAING ADD.. ~',STATE,ZIP E-MAIL ADDRESS '35—y ..c/T //44- A/4_ 5.w • Fedat'al wA-Li ,(,)d4_ CONTRACTOR COMPANY NAME CANT NAME OFFICE PHONE r2; h `..__- /e... S (fa, ) if . -/ /_ MAILING ADD CITY,- ATE,ZIP CELL PHONE 1' I •do .= �v : r. IF - A CITY OF FEDERAL W • =}'EINESS LICENSE NUMBER EXPIRATION DATE FAX NUMB • i CONTRACTOR'S REGISTRATION NUMBER EXPIRATION TE E-MAIL ADDRESS F Sw\fit 12/3(/01 APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE SwF as 04ve_ ( ) - MAILING ADDRESS CITY,STATE,ZIP CELL PHONE 1 ) - RELATIONSHIP TO PROJECT FAX NUMBER ❑ Architect ❑Tenant ❑Agent ❑ Other ( ) - PROJECT NAMES (� f PRIMARY PHONE E-MAIL ADDRESS CONTACT (_Ino{.Se- r/e44 ,e .'mss (25-? ) -G-zgei LENDER NAME Per RCW 19.27.095: Lender tnforn ation is required if project value exceeds$5,000. MAILING ADDRESS ' CITY,STATE,ZIP PHONE ( ) • DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE i . EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ ,5�,(1' SPRINILERED BUILDING? ❑YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES ❑NO WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER ❑ LAIEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) • PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST SECOND THIRD ADDITIONAL FLOORS(DESCRIBE) DECK(0 COVERED OR ❑UNCOVERED?) GARAGE 0 CARPORT 0 • NUMBER OF FLOORS sasTmo PROPOS= I TOTAL TOTAL aaefLOD sr TOTAL PROPOSED Of TOTAL err **NEW HOMES ONLYee NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ • FIXTURES Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. MECHANICAL • Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION) AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES BBQS FANS GAS WATER HEATERS MISC(Describe) BOILERS FIREPLACE INSERTS HOODS(commad s COMPRESSORS FURNACES RANGES DUCTS. • OAS LOG SETS REFRIG.SYSTEMS PLUMBING BATHTUBS IarTub/show•rcembot _ LAVS(Bathroom sinks) URINALS . MISC(Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS • DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Tones) ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBBS SUMPS SIGNATURE I certify under penalty of perjury that I am the property owner or authorized agent qj the property owner.I certify that to the best of my knowledge, the Information submitted In support of this permit application is true and correcct.I certify that I will comply with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit I understand that tie issuance of this permit does not remove the owner's responsibility for compliance with local,state,or federal laws regulating construction or environmental laws. 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, 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 apart of application. SIGNATURE: DATE / Property Owner and/or Authorized Agent o NEW o ADDITION o ALTERATION a REPAIR a.TENANT IMPROVEMENT BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a.YES o NO ZONING DESIGNATION CHANGE OF USE? a YES o NO NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? o YES o NO Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application