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07-102613 a 'RSCS4 ED _ 1 p CP �, Federal Way AY 1 Q7PERMIT ( � 1 S� MF CO ME EL PL DE EN FP COMMUNITY DEVELOPMENT SERVICES IY' 33325 en AVENUE SOUTH•63 971 9718 I C A T I O N FEDERAL WAY,WA 53-8 98063-9718 TD j / q / 0 7 253.835-2607 FAX 253-835-2609 /•�Y g„ un»w.rituoffederulwau.com /• BUILDING DEPT° The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type. r _ 0 PROPERTY INFORMATION C L{ SITE ADDRESS 3 1 ve s^ ° Q 0 Z5 SUITE/UNIT# ASSESSOR'S TAX/PARCEL# Q{ ) . CP T _- _ _^ LOT SIZE(sf) 7 T1 0 LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal description) �■ PROJECT INFORMATION 1 TYPE OF PERMIT &BUILDING ❑ PLUMBING ❑ MECHANICAL I ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM 1 PROJECT DESCRIPTION (Provide detailed description of work included on this permit onit)) l I PROJECT NAME(Name of Business or Owner Last Name) TY 1 v �"� ( ��P vO� I II PEOPLE INFORMATION OWNER PROPERTY NAME ,���� ' CI 1°73 PRIMARY)x%32 - .31''j MAILING D RZSS ($1-A- � 5...\"... �Y, t 1STATE,ZIL ( .S4" ,....0 E-MAIL ADDRESS CONTRACTOR 9MALY NAME sr PWCANelL (36 6) rt� - Z3 MAILING ACRDRESS CITY,STATE,ZIP ��! CELL PHONE 303 1 wo S-O,) U�w'W o�-+((hiv ri 4 i -; C ( 2I3) 6S - 15t(s CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER 67- (0Z.lve(3 'c o ( 2 .3 (-07 ( ) - coPY d \ CONTRACTOR'S REGISTRATION NUMBER /� J E/X/PIRATION DATE E-MAIL A ADDRESS /�/� .t ' �-,: C1W 1s-z , (S 7- l/ ©1 of Q(Q4Ic)cQ.e CCiAC . APPL CO PANY NAME AP ICAf1N 1 OFFICE PHON �e�0,0 ADDRESS CITY, 6 PHONE '30; 1-t4 ww�Sa)J T.N L 0 VLI1 v J ( J4 98jGQ (ZS3 ) SS3 -i Sqg-- RELATIONSHIP TO PROJECT FAX NUMBER ❑ Architect ❑ Tenant gent ❑ Other (3( ) �7Z - Cr13 Z PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS lac- (--o7,--- CONTACT ( ' ac- I a! ( ) - LENDER NAME Per RCW 19.27.095: Lender information is required if project value exceeds$5,000 MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) N DETAILED BUILDING INFORMATION EXISTING USE ' VCS-1 WAY , PROPOSED USE S/191444-4-- EXISTING ASSESSED/APPRAISED VALUE$ 5 Z5 0 VC) VALUE OF PROPOSED WORK $ 33 45-c). SPRINKLERED BUILDING? ❑ YES XO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES O WATER SERVICE PROVIDER KEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) di .—ce,-- AREA DESCRIPTION EXISTING PROPOSED• TOTAL • S .FT. S .FT. BASEMENT 9 -z31�l /0 It` ' -i--• FIRST ( LN /'Ur ` t' SECOND Ai i THIRD ADDITIONAL FLOORS(DESCRIBE) N • j • DECK(O COVERED OR NCOVERED?) t 2 5..•.Z/ ,Z c •GARAGE 7 jam CARPORT ❑ I t© EV/i F / El \ NUMBER OF FLOORS W M PROPOSED I TOTAL TOTAL&TleTINO SP TOTAL SP TOTAL sr _ "NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ • a 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 WIDH APPLICATION) AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES BBQS. FANS GAS WATER HEATERS MISC(Describe) BOILERS FIREPLACE INSERTS HOODS(commerdai) COMPRESSORS FURNACES RANGES ' DUCTS GAS LOG SETS REFRIG.SYSTEMS PLUMBING BATHTUBS(or Tub/Shower combo) LAVS(Bathroom Sink.) URINALS MISC(Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS Toilet) ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBBS SUMPS SIGNATURE I certify under penalty of perjury that the information 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 relianc the city,including its officers and employees, upon the accuracy of the information supplied to the city as a part of this application. / NAME/TITLE � /OW ?�LD / r"lf ATE ( ' t 67 (Signature) )Title) RELATIONSHIP TO PROJECT ❑ Owner ❑Agent contractor ❑ Architect ❑ Other o NEW o ADDITION ❑ALTERATION o REPAIR o TENANT IMPROVEMENT BUILDING SHELL ONLY? o YES o NO . BASIC PLAN? o YES n NO ZONING DESIGNATION CHANGE OF USE? o YES a NO NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO PLATTED LOT? o YES 'o NO DEMO PERMIT REQUIRED? o YES o NO Bulletin#100—April 2,2007 . Page 2 of4 k\Handouts\Permit Application