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07-103651 CITY OF © _l_ Q L Federal Way RECEIVW PERMIT . MF CO ME EL PL DE EN 4,10 COMMUNITY DEVELOPMENT SERV ICES 33325 AVENUE SOUTH• BOX 9718 2 p p L I CATION T° FEDERAL WAY,WA 98063 63-97]8 253JUL 6 0 C -835-2607•FAX 253-835-2609 LJ L wWnn.ciltlollederahnau.corn P���I AL WAY / The following is rtE jiih'1'ea1,` Pi(p -an incomplete application will not be accepted. Please print legibly(in inkJ -type. _- U1LLiPj,1 - L. /j� 0 PROPERTY INFORMATION J SITE ADDRESS_ 2,4= ( 2 Z ?0 T� 491/1 J U/ SUITE/UNIT# ASSESSOR'S TAX/PARCEL# 0 ( ? ( () - T ^ 7� LOT SIZE(sj7 LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) CJ (Attach separate page for lengthy legal description) MI PROJECT INFORMATION TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ,IRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu) N (7 4C\l :r Spr ; NKl-er .systems 4c,0 3fR 2.er A) G;3k C3-0 5.j Ste- '- a ( c cc.l +aA.,a(avis PROJECT NAME(Name of Business or Owner Last Name) 6),4 t l'e A S Ca e., NI PEOPLE INFORMATION PROPERTY NAME Tp��,� ''� / PRIMARY PHONE OWNER I `.'Yt 1 c17Y�l&rtIe Lit) Ie _ - ( ) - MAILING ADD E CITY,STATE,ZIP E-MAIL ADDRESS A 96a, A n 'c /( ,5„) CONTRACTOR COMP NY Np E 1 APPLICANT NAME OFFICE PHONE MAILIN A RE/S/J�����_y/�`! `l�� /��+i"S CITY,S�}T TTTE,ZIIP G` 877 /CE�,L�LL PHONE CITY FEDERAL WAT BUSIN�S LICENSE NUMBER EXPIRATION DATE / FAX NUMBE"11 5 711 I 2c - o5-- JoL{ 00 4-60 L. ( 2-3/-o-7 ( ) - COPY oIcard required CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE ��- )77 E-MAIL ADDRESS with each application I > {�Q � "�h l�p /"_ (3c A /c e6-- (L' -o�/ , 1 L f V r le/ -/7 �V a APPLICANT COMPANY NA APPLICANT NAME OFFICE PHONE ( ) MAILING ADDRESS CITY,STATE,ZIP CELL PHONE ( ) RELATIONSHIP TO PROJECT FAX NUMBER ❑ Architect ❑ Tenant ❑Agent ❑ Other ( ) - PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS CONTACT (Lf2 ) 'E•( 7 - Si a p I LENDER NAME Per RCW 19.27.095: Lender in ation is required if project value exceeds$5,000 MAILING ADDRESS - CITY- TE,ZIP PHONE ( ) ■ DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ .. 0� OCX) SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? .14.rYES ❑ NO WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) AREA DESCRIPTION ,�,,,�,.o m,�•.,a�,..,,�.,�.w.,.,.,��.>�,..�,�.�EXISTING PROPOSED TOTAL SQ.FT.• SQ. FT. SQ. FT. BASEMENT 116 1 FIRST SECOND 1 THIRD III ADDITIONAL FLOORS(DESCRIBE) DECK(0 COVERED OR ❑UNCOVERED?) GARAGE ❑ CARPORT ❑ 1 •NUMBER OF FLOORS ExurnsO PROP D TOTAL TO/AL EOSTJNG sr TOTAL PROPOSED sr TOTAL Sr — ,' "NEW HOMES ONLY" NUMBER OF BEDROOMS N\\ ESTXiGIATED SELLING PRICE $ ■ FIXTURES Indicate number of each type of fixture to be installed or relopated as pdit�of this project. Do not include existing fixtures to remain. • � MECHANICAL j Value of Mechanical Work$ (A COPY OF OR ESTIMATE MUST R INCLUDED WITH APPLICATION) AIR HANDLING UNITS EVAPORI4IVE COOLERS GAS PIPPQUTLETS WOODSTOVES 1 BBQS FANS •° GAS WATER IIIi 1TERS MISC(Describe) BOILERS FIREALACE INSERTS HOODS(Commercial) COMPRESSORS Fl) NACES RANGES DUCTS /AS LOG SETS REFRIG.SYSTEMS PLUMBING l BATHTUBS(or Tub/Shower Combo) 7 LAVS(Bathroom Sinks) URINALS MISC(Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS rroile) 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 reliant= • 1 city, including its officers and employees, upon the accuracy of the information supplied to the city as a part of this application. , NAME/TITLE DATE 7-c 7— C. (Signatur) (Title) N\ ,... RELATIONSHIP s PROJECT ❑ Owner 0 Agent ❑ Contractor ❑ Architect ❑ Other o NEW o ADDITION o ALTERATION o REPAIR a TENANT IMPROVEMENT BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO ZONING DESIGNATION CHANGE OF USE? ❑YES o 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 11100—April 2,2007 . Page 2 of4 k\Handouts\Permit Application