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07-105933 1 pp n^ CITYEIVOP 0 OF d ) i- [ 5_c, 3 ,� Federal Way OCT 2 5 2007 PERMIT SF MF CO ME EL PL DE ENO COMMUNITY DEVELOPMENT SERVICES 33325 D AVENUE.WA 9•09- M PLID I CATI O N FEDERAL WAY.WA 980 - �ULRl�L / 253-835-2607•FAX 253-835-2 )LD)NG DEPT f / www.rthloffederatwati.com . The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type. • PROPERTY INFORMATION v 1 SITE ADDRESS_ (5o�O)S a//s^ir cA f 1Te, 5- t e d e r a( („,c ( U J'I SUITE/UNIT#_ 4" ASSESSOR'S TAX/PARCEL# w 2�--� d ©(' t b - LOT SIZE(sf) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) A:-- _.c Q, 1-Y1-e,c,(C,�.,4-� K St-cw.J1— - 4r (Attar parate page for lengthy legal description) • PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION ❑ ELECTRICAL 0 ENGINEERING }Ll FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) Tyls"1-QJ k n crn / rrloc i cry-�-\crr, O.-4'\ n t 1 U. S C%taJucrr, Fire S -ream TeX Q \pe c i Pt c.a. cry)s PROJECT NAME(Name of Business or Owner Last Name) P�13'('p,C./CA... 1-4QJUC1l Q5' O.... .irCLA L II PEOPLE INFORMATION PROPERTY NAME ,/1 ^ / t PRIMARY PHONE OWNER Sr -4-V 1 4-5 C EJ l�t�C Vt -D h 5 LL L'. ( ) - MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE i2. 4,T- Rood 0.114 Duct Svc-S iz-r)5ten micVienfr( aaortala -0541-0 MAILING ADDRESS CITY,STATE,ZIP CELL PHONE Co(0 0 1 c Acve. S - 3eatttu. wi '1E5108 ( ) - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER 14i ci(; iG`-5 W i CC 6 (col; )1-(01- - at)0I- CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS aliOOD 084)CI I- res/1 / 0 j-- APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE ( Govvr'actor ) ( ) - MAILING ADDRESS CITY,STATE,ZIP CELL PHONE ( ) - RELATIONSHIP TO PROJECT FAX NUMBER 0 Architect ❑Tenant ❑Agent o Other ( ) - PROJECT NAME PRIMARY PHONE 4.0 E-MAIL ADDRESS CONTACT Y r `j11"e t MIrii eJt te,r ( Gad 1-(I - 0° LENDER NAME Per RCW 19.27.095: Lender information is required if project value exceeds$5,000 MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) - • DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE /�'�/�� EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 'S(A,...) ( SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE o PRIVATE(SEPTIC) • ID • PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST SECOND THIRD ADDITIONAL FLOORS(DESCRIBE) DECK(❑COVERED OR 0 UNCOVERED?) GARAGE 0 CARPORT ❑ NUMBER OF FLOORS EXISTING PROPOSED ,i TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF �, / **NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ • FIXTURES Indicate number of each type offecture 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 -.'ORATIVE COOLERS /GAS PIPE OUTLETS WOODSTOVES BBQS FANS N GAS WATER HEATERS MISC(Describe) BOILERS FIREPLAC'` SERTS HOODS(commercial) COMPRESSORS FURNACES RANGES DUCTS GAS LOG SETS REFRIG.SYSTEMS PLUMBINGN. BATHTUBS(or Tub/Shower Combo) LAV (Bathroom Sinks) - URINALS MISC(Describe) DISHWASHERS -1 NWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS trmleq 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. U/� SIGNATURE: e-i ' " C l f O _ DATE I©/c /O Property Owner and/or Authorized Agent FOR OFF/CE USE ONLY'. o NEW o ADDITION ❑ALTERATION o REPAIR o TENANT IMPROVEMENT BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? o YES ❑NO ZONING DESIGNATION CHANGE OF USE? o YES o NO NEW ADDRESS REQUIRED? ❑YES ❑NO UP/SEPA/SU? o YES o NO PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? o YES o NO Bulletin#100—August 16,2007 Page 2 of 4 k\Handouts\Permit Application