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05-100123 RECE VE 110 aAaa° _ �moFtill15 / Federal Way PERMIT / a.0 5 COMMUNITY DEVELOPMENT SERVICES "' TT"7 Oi FEDERAL WA'' F MF CO ME EL PL DE E 33325 8TH AVENUE SOUTH•PO BOX 9718 PT, FEDERAL WAY,WA 98063-9718 A P P L I C A T rag TO / 253-835-2607•FAX 253-835-2609 ,� www.cituoffederalwau.com The ollowi • is re. ired in ormation-an inco •fete a••lication will not be acce•ted. Please •rint le!ibl in in or p e. �+, • PROPERTY INFORMATION SITE ADDRESS (?)c3410 CJ 00E. SUITE/UNIT# / 0, ASSESSOR'S TAX/PARCEL# - LOT SIZE(s) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal descrphon) ■ PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING B FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of wo included on this permit onlu) �t.I u a a 2,, _ . C) QO(ry�d(.+., --A/%11.-"."1"-' 1.r7,,c)CO Crc\o . 3"3 �‘k1 �.. �I "' • 6-1.. tnk-1, 25 cedk'� w �k ay\cA C€t(. r1 C PROJECT NAME(Name of Business or Owner Last Name) —1 J{-6N52_ 6 P Jr \ ( ,U �-�✓ • PEOPLE INFORMATION v PROPERTY NAME //pp PRIMARY PHONE OWNER d d S I LC- ( ) MAILING ADD ESS 1 CITY,STATE,ZIP CONTRACTOR COMPANY NAME r APPLICANT NAME ^ OFFICE PHONE --iNorl-k-i Cyr., Sk0-14 i191-1-t) '1/2--I(C, !I' wIra )cge -ig C 0 MAILING ADDRESS CITY,STATE,ZIP CELL PHONE ‘VD (Q r,.�--4 c a `roc , (J6R 9 5� q- ( ) - CITY OF FEDERAL WAY BUSINESS LICENSE NUMB ,� EXPIRATION DATE FAX NUMBER CONTRACTOR'S REGISTRATION NUMBER(copy of/card required with each application) EXPIRATION DATE APPLICANT ,MPANY N E LICANT�;A^ME OFFICE PHONE "" I' n (� 5 li x(117 Ss. ri l l( % < 'A,� � �g rvy/I!'ADDRES��'.: /i) ' Ae ? C V IIP �a i,t,i' (ELL PH)NE - RELILATTIIONSHIPTOPR'OOJjECCT) BE /� 0 Architect 0 Tenant 0 Agent 0 Other(Describe) N ) 'r/l�` CONTACT N ,55t::1 c Hello) PRIM''Y P ft ; E-MAIL ADDRESS LENDERspsp., e © "* MAILING ADDRESS CITY,STATE,ZIP �1��y�p • DETAILED BUILDING INFORMATION �1 EXISTING USE (C t!a f l�A C_ Q PROPOSED USE `Cyr)rnairC---) <S� EXISTING ASSESSED/APPRAISED VALUE $ Zi C) VALUE OF PROPOSED WORK $ SPRINKLERED BUILDING? 1 &YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?T4YES 0 NO WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) • , PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE ❑ CARPORT 0 EXISTING PROPOSED TOTAL tors X n QSM' TOI q ,* / NUMBER OF FLOORS s i l **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 $ AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOODS(commercial) WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS(or Tub/Shower combo( SHOWERS WATER CLOSETS(Toilet MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST _ WASHING MACHINES URINALS HOSE BIBBS LAYS(Bathroom sinks( VACUUM BREAKERS ELECTRIC WATER HEATERS DISCLAIMER/SIGNATURE BLOCK 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 authorised 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 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. I NAME/TITLE 1_O(t AJ.X.A IVP 1 DATE „i/I t/ (Signature) (Title) RELATIONSHIP TO PROJECT 0 Owner 0 Agent contractor ❑ Architect 0 Other d aw � tt i aM ft ;\ ` � - , c: v I�, SU; a , // 5;. �\d/ y f ®ti// bI : fia t 'AIWA 3 ; 6 !!0 • i $ R T. C i , •-•,e'" ��m , ;ts• s .re i J / 1*...,410 / )SE */ ? \ 1t ,/ y gi IY� i W, / ., 1**AsPERM'` Q , t < Bulletin#100—August 19,2004 Page 2 of 4 k\Handouts\Permit Application