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06-102662arms Federal Way COMMUNITY DEVELOPMENP SERVICBs 33325 81w AVENUE SOUIN • PO BOX 9718 FEDERAL WAY, WA 98063-9718 253435.2607• FAX 253.835.2609 unuro rityo ederalmcy com Thefollowina is I -Sl 3 RECEIVEd PERMITMAY 3 0 zoos APPLICAI,I NDERALVI BUILDING DEPT. - an &- 2_& �72- MF CO ME EL PL DE EN FP will not be accepted. Please or SITE ADDRESS CJ' -I ; (�� �^ Ay e OFFICE PHONE SUITE/UNIT # ASSESSOR'S TAX/PARCEL # 2- 5 Z I - =1 Q + LOT SIZE (s]) LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) iAttmh &V—fePage/-MVfhg Iegaide&.0dwQ ■ PROJECT INFORAIATION TYPE OF PERMIT BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this nernit ordul D +=T rf � n F sr. - � x -r 12 ' " tic PROJECT NAME (Name of Business or Owner Last Name) PROPERTY OWNER CONTRACTOR APPLICANT CONTACT LENDER PEOPLE INFORMATION NAME PRIMARY PHONE �J-ZCzSL. t v ti MAILING ADDRESS CITY, STATE, ZIP 35-7)7 t In L^J — (.- COMPANY NAME APPLICANT NAME OFFICE PHONE Cx-i CITY, STATE, ZIP – CELL PHONE MAILING ADDRESS CITY, STATE, ZIP CELL PHONE CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE .- FAX NUMBER 'L --B NTRACTORS REGISTRATION NUMBER (eopy of card required with each application) EXPIRATION DATE L COMPANY NAME 5AvAnE At5 0 ��►.� APPLICANT NAME OFFICE PHONE ( 1 _ MAILING ADDRESS CITY, STATE, ZIP – CELL PHONE RELATIONSHIP TO PROJECT FAX NUMBER ❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe) 1 ( _ EXISTING USE _ - r_� t a . SSLA-4 12 e r " � PROPOSED USE SC'G- � EXISTING ASSESSED/APPRAISED VALUE >���, QnC )` "-' VALUE OF PROPOSED WORK $ I l . Oc `Y') ' °" SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ N.0 WATER SERVICE PROVIDER .X LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) SEWER SERVICE PROVIDER ALAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC) AREA DESCRIPTION EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL SQ. FT. BASEMENT FANS HOODS (commerdaq WOODSTOVES FIRST FIREPLACE INSERTS RANGES MISC (Describe) SECOND FURNACES GAS WATER HEATERS THIRD GAS PIPE OUTLETS FOURTH ADDITIONAL FLOORS (DESCRIBE) SHOWERS WATER CLOSETS ll'nueq MISC (Describe) DECK(COVERED?) SINKS DRINKING FOUNTAINS GARAGE CARPORT ❑ CA91j c SUMPS 01� S� —IQV NUMBER OF FLOORS Magma Paorosco TOTAL :........__„....... r .. "NEWHOMES ONLY” NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ 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 (commerdaq WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC (Describe) ' COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS (arTLb/she rcambq SHOWERS WATER CLOSETS ll'nueq MISC (Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS paahro mss VACUUM BREAKERS ELECTRIC WATER HEATERS I cert{jy under penalty of perjury that the tgormation 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 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 cigr1hel pding its officers and employees, upon the accuracy of the information supplied to the city as a part of this application. r101 NAME/TITLE RELATIONSHIP TO Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other S- ILA -06 1 Bulletin #100 — January 7, 2005 Page 2 of 4 k\Handouts\Perinit Application LEGral. Deltic, 25203 5'i S tIof=-r OF V-1 FZ' OF W \-ISFT Of= E G6O FT Off- Cs�-2