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08-104779 �� .'�, Wig _ i Q / i 7 i_ PER1Vl�IT` ��., COYIRQNATnsvzLOPAffiNTSSRVIt T �0�8 SF MF CO ME EL PL DE E ( 22225."I .��I � FBD&L!6 WAY,WA 98069.9718 R /I CATION N 2598952607•PAX 259-825.269 /0 / ` 0 /..1 col?// FEDE The following is required 1q4l1iation-an incomplete application will not be accepted Please print legibly(in trek)or type. III MI PROPERTY INFORMATION )(SITE ADDRESS 3 2.6 3 S W J7 -s k Pc N 1- teeAri SUITE/UNIT# ASSESSOR'S TAX/PARCEL# L.j]. gi / Q .rte- [ Q 5 LOT SINE(sfl LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Moth•mom•Pate Air krod,hoed orplW MI PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL f 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING DIRE PREVENTION SYSTEM --PRO DESCRIPTION(Provide detailed description of work included on onlut,Q i =: 1iT - /1 EmcVr" E)f/ f� A);:c4.- �On/T�cP> lRs/r�E/ t 4` I\� //9-G/4 �..fi/`/-! , . .�) �(�7 .L d C7 , 1 S - / 4�' S_PROJECT NAME(Name of or Owner Last Name) .1.4- E x1 a✓E of 724~/, y �� S 74 r c.7i— PEOPLE INFORMATION ,( PROPERTY NAME - PRIMARY PHONE (`OWNER e A ( ) - O ADDRESS / CITY,STATE,ZIP E-MAIL ADDRESS I )(CONTRACTOR COMPANY APPUCANT NAME OFFICE PHONE C;414 /`, 4c- c a.L✓ J,4 L-4 GI-ii es a•.i (2 S3) 5'z 6 - 3 Z oU MAILING ADDRESS CITY,STATE,ZIP CELL PHONE 2c6471-,6 y?r/4-or- (•e<4,-/- . /5 ' ' ka.4. Q'r'2q (2o(0) fcvl - 13.2.3 CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER J EXPIRATION DATE FAX NUMBER -420 -; s4OE .» d 04, - .0- 1r a �� O�J (2�3 � �a6 370E NU BER C/e4L.PR 932._ Q Z /// 2oc www. ca(paetee1;.....cn,,,, APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE , ►C- A-s ..! e - MAILING ADDRESS CITY.STATE. •1 CELL.PHONE ( ) - RELATIONSHIP TO PROJECT FAX NUMBER CI Architect a Tenant a Agent a Other ( ) - PROJECT HAM. PH oNTACT 4 71e�Z'- I' 4S o.N ( ) 0 (- 1 3 23 j EMAIL ADDRESS LENDER NAME Per RCW 19.27.095: 6ybrmation is •r*"`i . - 'shat saonods MAILING •DRESS ( • DETAILED BUILDING INFORMATION EXISTING USE . :1.POSED USE !OUSTING ASSESSED/APPRAISED VALUE VALUE OF PROPOSED WORN S 4. — "- O d I) SPRINICLERED BUILDING? a YES; a NO FIRE SUPPRESSION : . '''''• • - I t; :'1' . r-. • WATER SERVICE PROVIDER a LAKEHAVEN a HIGHLINE a TACOMA a PRIVATE(WELL) SEWER SERVICE PROVIDER a LAKEHAVEN a HIGHLINE 0 PRIVATE(SEPTIC) f PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST '311PO1!lI2 THIRD ADDITIONAL FLOORS(DESCRIBE) ' DECK(0 COVERED OR ❑UNCOVERED?) GARAGE ❑ CARPORT ❑ .`` .> - stsrsew rr wwarosw er zarc er . reoraess rots w»r� " NUMBER OF FLOORS f '!NEW fIQDES ONLY* NUMBER OF BEDROOMS :/ ESTIMATED SELLING PRICE $ • Indicate number of each type of funWure to be installed or relocated as part of this project Do not include existing fi lures to remain. Value of Mechanical Work$ COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION) AIR HANDLING UNITS EV •RATIVE COOLERS GAS lir •U'ILETS WOODSTOVES BBQS FANS ' ATER HEATERS MISC(Des ribe) COMPRESSORS FURNACES RANGES DUCTS. GAS LOG SETS REFRIG.SYSTEMS PLUII R(NG MISC(Describe) BATHTUBS p rowsssmr cow* LAYS . . slots) URINALS DISHWASHERS • I 'PER SYST VACUUM BREAKERS DRINKING FOUNTAINS •WERS 'WATER CLOSETS(s.q ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBBS SUMPS SIGNATURE I certVg under penalty 0f perJury that t as the property owner or authorised agent 4f the property owner.I certify that to the best of my tae,the hyronnation subsitt!d hi support of this permit application is true and correct.I certify that I will comply with all applicable City g f ltedersd WA"regutlatlOns pertaining to the Work authorised by the issuance of a permit.I understand that the issuance of this permit does net remove the owner's responsibility for compliance with local,state,or federal laws regulating construction or environmental laws. I farther agate to hold harmless the City of Federal Way as to any elate(including costs expense;=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. sIGNATVRE: J(---2 DATE /C-2// 0/2©© Properly owner or Authortie a NEW o ADDITION a ALTERATION a REPAIR 0.TENANT IMPROVEMENT BUILDING OEM&O N?` 0 FEN n NO.' BASIC-PLAN? • o7T118 DM ZONING DESIGNATION CHANGE OF USE? a YES a NO NEW ADDRESS REQUIRED? ;,;a YES a NO UP/SEPA/SU? : a.YES ,..a NO PLATTED LOT?. _ a YES a NO DEMO PERMIT REQUIEM? a YES a NO Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Pemrit Application