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08-101524 RECEPtirED ak !IPS } clrraF - o l 6 z 9 Federal Way ( {{{ MAR 28 ;� COMMUNITY DEVELOPMENT SERVICES 1.1.4'4PERMIT SF MF CO ME EL PL DEE FP 33325 811 AVENUE, •PO BOX 9718 JATION 253 FEDER835AL 2607 WAY FAXWA 253 WA 5399 ,�6 9 OF FE / / The following is required informatii -an incomplete application will not be accepted. Please print legibly(in ink)or type. 2 /� ` - i ' 1N PROPERTY INFORMATION S SITE ADDRESS_ 3 V I — I`� W cu9 0 CATS ( / SUITE/UNIT# I© ' ASSESSOR'S TAX/PARCEL# q 2 Le 5 l./ q - C) 1 lQ C) LOT SIZE(4) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal description) • PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING)(FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this omit onl , mi•-/-h Fre S' s/e S rv%// e rl (,�/e,:f �p>_� /,E�q npn fflo.1 w (, 111.5 t�ei (r`n S. 1 t��0 �11 C k. I Qfl ri oc trc t to kz PROJECT NAME(Name of Business or Owner Last Name) e L/1 P(_CY i 6 /0 MI PEOPLE INFORMATION PROPERTY NAME PRIMARY PHONE OWNER 3 PktKel ?COC Cfi e5 1 LP ( MAILING ADDRESS Cr ,STATE,ZIP 1YE-MAIL ADDRESS CONTRACTOR PONY NAME APPLICANT NAME OFFICE PH E �` Fire�v1,�s C► vS,I0C- Ma_14-hea0 (Y111I r (aS3)Iwo- - 188o MAII�[NG ADIS_ ^ CITY,STATE.ZIP / -,Q [� CELL PHONE - /lJ�/lV� [-1( '{IAV/ r u� ��(CfTI �7�-� ( ) CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER /q g7"'.".6100(25-5- dO —BL. i )/3 Io8 ( s3 )9a6 -a3s0 CONTRACTOR'S REGISTRATION NUMBER IRA ION DATE E-MAIL ADDRESS 5m(_f�-i-Ps /30 C) l t/70170 Si ifiini//e 'i' /i2,Co v( APPLICANT COMPANY NAME /y� 'APPP(LII�fCANT AME /,,_ r OFFICE PH/'Oy�N^�rE/� LING s re- S(Citi I Si l nCe C11Y.STAN / • r'lie CELL PHONE -/F(0 f RETATIO S 5L/1-11 IP TO �6 o/)Q f C�49rq(T FAX NUMBER) - a Architect 0 Tenant ❑Agent a Other ( ) - PROJECT NAME PRIMARY PIA.n/ �j�j E-MAIL ADDRES �/ CONTACT /l Q f fh ew Ma/e (ai53) IU - /D d O �Iinwe ssin/Y91 TI/e,roivv LENDER NAME Per RCW 19.27.095: Lender information is required if project value exceeds$5,000 MAILING ADDRESS CITY,STATE.ZIP PHONE ( ) - M DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE / EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 31 Cf 00- SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? [ ES ID NO WATER SERVICE PROVIDER r/ - ' HAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL) / SEWER SERVICE PROVIDER ��LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC) • • PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST SECOND THIRD ADDITIONAL FLOORS(DESCRIBE) DECK(D COVERED OR 0 UNCOVERED?) GARAGE 0 CARPORT 0 NUMBER OF FLOORS EXLSTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF **NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ II FIXTURES Indicate number of each type offixture 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 WITH APPLICATION) AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES BBQS FANS GAS WATER HEATERS MISC(Describe) BOILERS FIREPLACE INSERTS HOODS(commercial) COMPRESSORS FURNACES RANGES DUCTS GAS LOG SEib REFRIG.SYSTEMS PLUMBING BATHTUBS(or Tub/Shower combo( LAYS(Bathroom Sinks) URINALS M1SC(Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSE lb(rose) ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBBS SUMPS SIGNATURE I certify under penalty of perjury that I am the property owner or authorized 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 Way regulations pertaining to the work authorized 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. 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, 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. 1,7 � /� SIGNATURE: �lrJ�al2��i'(7/ DATE 3A g/ g Property Owner and/or Authorized Agent /// FOR OFFIOE USE e]JI,°Y' o NEW o ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a YES o NO ZONING DESIGNATION CHANGE OF USE? o YES o NO NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? o YES a NO Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application