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07-101289 Fede a1 Way ESV p C2 I LC L a --5 COMMUNITY DEVELOPMENTSERVICEs�� E RM�T SF MF CO ME EL PL DE E FP 33325'8"AVENUE SOUM•PO BOX 9718 FEDERAL WAY,WA 98063.9718 AA p 1 2 Zoe p p L I C AT I O N TD / 253-835.2607•FAX 253-835-2609 1Y1 / UMW.cittpuIledemlwau.com (FERAL WAY . The following is rl BiaL ` i an incomplete application will not be accepted. Please print legibly(in ink)or. type. S PROPERTY INFORMATION SITE ADDRESS 3 L7 0 '-' .,7"211- /`P ,_C/-✓ SUITE/UNIT# /C-- ASSESSOR'S TAX/PARCEL# I' �'� " _ - LOT SIZE(sf) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) G '- /,NO t-j 2,1i h,-t/'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 El. E PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) /7",,e? /) e-x4J-.7%-/ P' y/./4C-,, ,)/0,2G, --(7',..r,e--4.-.7 7 , 0 o-''''-'/-c /d/L I.f C SOA"/fie ....-,...,,......- r- 61_1 _c_1/;(55 //i4(/ /_J-i &-zzi PROJECT NAME(Name of Business or Owner Last Name) . ''---PC-7�, � . _V©3"ice_A G./� _ • U PEOPLE INFORMATION PROPERTY NAME ® .........--•- PRIMARY PHONE OWNER /e",JG/Fed /I t.-v ,/,..4.1 "ES'/1.r'a'^' / ( ) -.. MAILING ADDRESS CITY,STATE,ZIP/ /� E-MAIL ADDRESS eHtiZ,//,0 :✓ .) 017,..../7-- .t-Y G�7^/// 1,0/ CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE .PrC, /0 (7,6)76'7if 5,5. MAILING ADDRESS CITY, ATE,ZIP CELL PHONE /'G}7 /Yz Z % C',,►//f c= /t�tJ'1, ( 7170 26)-- 'Z, CITY OF F(/_/_$RRA�//L WAY BySINESS LICENSE UMBE EXPIRATION DATE ty//y FAX NUMBER jCONTRA � CON t R/p/T�/1°�NUMBE F/ (z!/6 )7 yo7O COPY of ee,d regalmd EXPIRATION DATE E-MAIL ADDRESS !J with each eppllcatlon er/ ��/��'71`1E' D L7" 7 S /' es�sr�CAA>SD,/.../c--��/.jfi„ri• APPLICANT COMPANY NAME APPLIC,Ap T NAME OFFICE PHONE - /P `N eve' ' ` 4/0--- Sc-v/„/ (fit?c) 76,49 fifas MAILING ADDRESS CITY,STATE,ZJp CELL PHONE , /S' i5./Zz7 �er„./Lr 6,4-7 '-/`/may (ZdG) ZG3' - Z(y-Z r RELATIONSHIP TO PROJECT FAX NUMBER 0 Architect 0 Tenant 0 A enter _5-4,4 ( 2 c), ' '-"C, V PROJECT NAME /n/C-''.....- PRIMARY PHONE CONTACT /-- E-MAIL ADDRESS LENDER NAME Per RCW 19,27.095: • //17 Lender information is required if project value exceeds$5,000 MAILING ADDRESSCITY,STATE,ZIP PHONE /1' )/3 / 6-7- .U4,s,r// /t/9 %da/i ( w)j 7/ 9/ • • U DETAILED BUILDING INFORMATION EXISTING USE !fA Z5//r‘i..-r -",` PROPOSED USE rJ/h4s,tir ---... EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ /6e0 SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) AREA DESCRI,. EXISTING,., PROPOSED _ r . - TOTAL , • SQ;FT. SQ.FT. SQ.FT. BASEMENT FIRST SECOND THIRD • ADDITIONAL FLOORS(DESCRIBE) DECK(0 COVERED OR 0 UNCOVERED?) GARAGE 0 CARPORT El JOUSTING PROPOSED TOTAL TOTAL EXISTING Sr TOTAL PROPOSED SP TOTAL SI NUMBER OF FLOORS • **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 $ (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)commmcio COMPRESSORS FURNACES RANGES DUC(S. GAS LOG SETS REFRIG.SYSTEMS PLUMBING BATHTUBS(or Tub/Shower Combo) LAVS)Bathroom Sinks) URINALS MISC(Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS crone) 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),ivhich 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 an mployees, upon the accuracy of the information supplied to the city as a part of this application. • .. ///1 NAME/TITLE r DATE (Signature) (Title) L RELATIONSHIP TO PROJECT ❑ Owner 0 Agent 0 Contractor 0 Architect Ether $cr D NEW o ADDITION o ALTERATION o REPAIR o 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#100—January 1,2007 Page 2of4 kU-landouts\PermitApplication