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08-103347
-4;4'4' • ECEIV PERMIT SF MF CO ME EL PL DE EN + P COMMUNITY DEVELOPMENT SERV 33325383 4LWMY a `W L ' ° 2°0APPLI CATI O N r ,___--f--AEIBRAL WAY,WA 98063-9718 M/U/WC(UD' 'I'I OF FEDERAL WAY / The following is required,5eation-an incomplete application will not be accepted. Please print legibly(in ink)or type. ■ PROPERTY I?N?FORMATION SITE ADDRESS i M c CLAAA t4--" [7�©l rk'�' SUITE/UNIT# ASSESSOR'S TAX/PARCEL# 5 2-L C ,Ai'' - - ( o z1 A-'4 LOT SIZE(sf) ! LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) Sic_ `ai4u! � V''l t p1t)LE S `-c6O(._., (Attach Or len9ffilliellat deseriPtion) • PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING *FIRE PREVENTION SYSTEM - + 'ESCRIPTION(Provide tailed description of work included or • •- S •i otAJ�l__ 1 l Ept. 1010 0 - vLl bv3 k 2 i \ k-, = L wla- .5 f&1t_ A t L ''' \ PROJECT NAME(Name of Business or Owner Last Name) 4-.\&we^l- t'"`"'l`s J (� • PEOPLE INFORMATION PROPERTY OWNER Nr-eVEVI3A MAILING ADDRESS , rATE,ZIP , (�- i t q, E-MAIL ADDRESS 3 4u5 le _ r- ,0 "7 t �v+�- citbo3 CONTRACTOR t$A,PA NYE NAME (� OFFICE PHONE �_�� �7 U J10-upz 055)6[2-2-- -415' CELL PHONE 1 A17D �4f - Aua bUrt AziP - C16424 (Z i27) 606 -1324 CITY OF FICDERAL WAY BUSINESS LICENSE NUMBER 'EXPIRATION DATE FAX NUMBER --o2-(co >2 -o0,—. 7L- (?55 Z7___ -4)822) CO 3 EXPIRATION CEA � -t 2539 � lA1440- b i b E-MAIL ADDRESS APPLICANT c° NE12-10-C-445 4301)a--- APPLICANT NAME OFFICE PHONE - MAILING ADDRESS CITY,STATE,ZIP CELL PHONE ( ) - RELATIONSHIP TO PROJECT FAX NUMBER ❑ Architect ❑Tenant ❑Agent ❑ Other ( ) - CONTACT NA� , ^� ) Q Or _ 2,c E-MAIL ADDRESS LENDER NAME Uf Per RCW 40D6- 9.27.095: 42_ Lender information is required if project value exceeds$5,000 MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) • DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE 2 EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 7t, 1990 SPRINKLERED BUILDING? a YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES CI NO WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ 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 0 UNCOVERED?) GARAGE 0 CARPORT 0 • • NUMBER OF FLOORS I manna I mOiOns I TOTAL TOTAL sxamwsr TOTAL mom=87 TOTAL SP "NEW HOMES ONLY*' 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 Icommed q COMPRESSORS FURNACES RANGES DUCTS • GAS LOG SETS REFRIG.SYSTEMS PLU9�ING BATHTUBS Iornun/wooer cent* IAVS(scam=scrum URINALS' MISC(Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS Cron ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBBS SUMPS SIGNATURE I certify under penalty of perjury that I am the property owner or authorised agent of the property owner.I certify that to the best of my submitted knowledge,the information submitted in support of this permit application is true and correct.I certify that I will comply with all applicable City of Federal Wag regulations pertaining to the work authorised by the issuance of a permit.I understand that the issuance of this permit doss 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 a part of this application. SIGNATURE: E DATE b:::)() Property Owner and/or Authorized Agent a 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? o YES a NO NEW ADDRESS REQUIRED? a YES o NO UP/SEPA/SU? a YES a NO PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Pennit Application