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08-101594 -- 4-4,- RECEIVED F ral Way — —ir.>. CO,HMUNPIY DEVEJAPA,ENT PERMIT SF MF Co MfL DE EN�� 333256 AYENUE,WA9•63B� 0 2 ZoosAPPLICATION FEDERAL WAY,WA 98063-9718 m 253-8352607•FAX 253-8,35-2609 '`°--` '''''''i''CI Y OF FEDERAL WAY / / The following is required ffjrmation-an incomplete application will not be accepted. Please print legibly(in ink)or type. • PROPERTY INFORMATION SITE ADDRESS_ 3Zoz-o 3Z-PD o ki4 5- SUITE/UNIT it_ B ASSESSOR'S TAX/PARCEL# Z, 1 S If P) 0 - ® © 3 0 LOT SIZE(sf) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) Y 4,„,,P v j a PROJECT INFORMATION TYPE OF PERMIT ❑BUILDING 0 PLUMBING ❑MECHANICAL 0 DEMOLITION ❑ELECTRICAL ❑ENGINEERING S1 FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work+included on this permit only) ),v51.4^n F rte- A 1p rt�n f p.-- -I)//. Gf xi:p lq(W.irj(.,t--. 10 5tv\n k.r--s zl )4oi' 51 roj2d.,S PROJECT NAME(Name of Business or Owner Last Name) )C-.:1F, ,'C,C-, N PEOPLE INFORMATION PROPERTY NAME ,„ PHONE OWNER -i'c..,,...t., at, ■41V A.ervwW 'V S (2s3) -'723 e MAILING ADDRESS CITY.STATE.ZAP E-MAIL ADDRESS zit - 37 2.asJ1 21.,- lot.,-1. A C)609 3 CONTRACTOR COMPANY NAME APPLICANT OFFICE PHONE N3tr-12 - fin& 4. 55x-tit iT"l Li.... 5t i i M� R-t'1p2p (1.12S)'2-L-11.t -I444 S' MAILING ADDRESS COY,STATE.ZIP CELL PHONE 1.1 te01 e8 Lia PAM.. Nt Pa'11.,cS 0.., v.* 1162! (i►zc) -i4 - /44 - COY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER 07 - IOW?5 i2k) (00 (arGo) 1103 -1o1<4 CONTRACTOR'S REGISTRATION NUMBER EUpATION DATE E-MAIL ADDRESS 3 NR,s2.1F 1,,-,c (0/07 t34•,--4.,A.�,�•y.,:z ,.1-s-1" APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE MAILING ADDRESS CIIY,STATE.TIP CFJJ PHONE ( ) - RELATIONSHIP TO PROJECT FAX NUMBER ❑Architect ❑Tenant ❑Agent ❑ Other ( ) - PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS CONTACT (14 vs Nell C C+r15 f _ ( ) - LENDER NAME Per RCW 19.27.095: Lender information is required if prqiect value exceeds$5,000 MAILING ADDRESS COY,STATE,7IP PHONE ( ) • DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE , �-■� EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $'. -----1.411. SPRINK ERED BUILDING? El YES I3 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES ❑NO WATER SERVICE PROVIDER ❑I AKEHAVEN Q IMMUNE ❑TACOMA ❑PRIVATE(WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN n HIGHLINE 0 PRIVATE(SEPTIC) t 1 • • PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL .FT. .FT. FT. S9 S9 Sg. BASEMENT FIRST SECOND THIRD ADDITIONAL FLOORS(DESCRIBE) DECK(0 COVERED OR ❑UNCOVERED?) GARAGE ❑ CARPORT ❑ NUMBER OF FLOORS ESISTRIO Tom,. DOTAL R7351719 Sr anrxt.PROl08� - TOTAL SF "NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ FIXTURES Indicate number of each type offixture to be installed or relocated as part of this project Do not Inclorle 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 icano.o is l COMPRESSORS FURNACES RANGES DUCTS GAS LOG SLrS REFRIG.SYSIIMS PLUMBING BATHTUBS(or Mb/Shower Combo) LAVS(Bathmmn Sinks) URINALS MISC(Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Rau) 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 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 Wray regulations pertaining to the work authorised by the issuance of a permit.I understand that the issuance of this permit does not remove the owner's responsibility for compliance with local,state,or federal laws regulating construction or environmental laws. /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 dofense 4f such - which may be made by any person, including the undersigned, and filed against the City,but only where such claim arises out off .• of the including its officers and employees,upon the accuracy of the information supplied to the city as a part of this app Z SIGNATURIft DATE 4 1 ?)I Property Owner and/or Authorized Agent FOR OFFICE USE ONLY ❑NEW a ADDITION ❑ALTERATION a REPAIR a TENANT IMPROVEMENT BUILDING SHELL ONLY? a YES a NO BASIC PLAN? o YES a NO 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 n NO DEMO PERMIT REQUIRED? a YES a NO Bulletin#100-January 1,2008 Page 2 of 4 k\Handouts\Permit Application