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07-104398 r t • RECE MO • Federal WayAUG0 8 2007 n - 0 . 21 A PERMIT SF MF CO ME EL PL DE EN CD COMMUNfrYDBVELOPMENT SERVICES 33325W*aAV WAYS.WA 9;073BOXR7�Wv or FaDe 'LI CATION ON FEDERAL WAY.WA 98063-971�I't � � 253-835-2607•FAX 253-835-2609 BUILDING • _._.__ - www.cituoifederaltvau.com The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type. Li ( • PROPERTY INFORMATION Lt SITE ADDRESS 3 15t ` re- , otAxif1 0 SUITE/UNIT# ASSESSOR'S TAX/PARCEL# 7 5 U ¶ `1 - 0 c20 LOT SIZE(s_f) 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 1131 FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work incl!rivd on this permit only) Fir' ,'!(avvv'T : ,Ad d. fo e, �fiv� ;w�.] Lii©oLA . K N pa -f fir A� t u.c io *It su.&Q cL.vJ:C. . 114 r�Uxh�ivi,vt&e.1. yr vi i ) ADtrAcA t vt tiCt , lv• i (. /� . may_ G) {�Q PROJECT NAME(Name of Business or Owner Last Name) ` 1' r Y 1 V 3 p. 'C ei'k� t,�Ca'.'$ 6,e p, fAr.1_ • PEOPLE INFORMATION PROPERTYNAME PRIMARY PHONE OWNER ErEan Ct9Cart H t 0.Q /\ 3164.I.t-, -\A-/ (?.6'3)%ti _97©t MAILING ADDRESS _ CITY,STATE,ZIP E-MAIL ADDRESS t1 t S vLA-K\ : ch^ek-t 1 c:.i-ovW w A 4M x t z tZ CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE —11,\U M pyo r‘ euuckr-i Cci. CO✓NI-, (v‘C. 4,1-k,,, D°Kean (11.00-0)� ) ( 436 3) ski - ��� Mao G Cox J O� v O STATE,-1. L t�ZIP A ' o�'C ' (CELL PHONE CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER 2& • GI • toZ'(toI • Co • 3C. (7- 31, 01 ( ) - EXPIRATION DATE E-MAIL ADDRESSC43Yo[crteppCONTR�ACTO1pRSSREcGISTRA$TIpONc.NUMBER ?' tQ ©(Q APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE St m pLizAc Ciri oLvv c-L-( 1(.40W- cv Reitr. (1 ) 1I - l ia-I0 MAILING ADDRESSCTTY,STATE,ZIP CELL PHONE CI)j,0 t0�"� AIX-, S • t DO Gyula tavr h -)P ( t) p 1( - RELATIONSHIP TO PROJECT .J FAX NUMBER 0 Architect 0 Tenant I Agent ❑ Other 6110A-V-) Cc'rItY2i-L to - (-0..0(0) r,1( - (GjVO PROJECTNAME PRIMARY PHONE E-MAIL ADDRESS, CONTACT (kt ®rReo�r ( ?. ) 2.-Cii - 14-14.0t Korea/oJ tyc o i v4• Cl tV' LENDER NAME tol Per RCW 19.27.095: Lender information is required if project value exceeds$5,000 MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) - • DETAILED BUILDING INFORMATION p EXISTING USE W\// 1 PROPOSED USE Cr EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 3S , D O SPRINKLERED BUILDING? jXeYF,S ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES 0 NO WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) • Y t' ■ PROJECT FLOOR AREAS - 1 AREA DESCRI' ' • EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT \ CFIRST'-..- ti'.A _ SECOND THIRD ADDITIONAL FLOORS(DESCRIBE) i' DECK(❑COVERED OR 0 UNCOVERED?) GARAGE 0 CARPORT 0 NUMBER OF FLOORS EXISTING PROPOSED /� TOTAL dYwr erusrmosr TOTAL PROPOSED sr TOTAL SF "IVEW HOMES ONLY" NUMBER OF BED1259,MS. ESTIMATED SELLING PRICE $ Indicate number of each type o fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. MECHANICAL 1Q Value of Mechanical Work f' ."v (A COPY OF BID OR ESTIMATE BE INCLUDED WITH APPLICATION AIR HANDLING UNITS APORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVE BBQS F•` i GAS WATER HEATERS MISC(Describe) BOILERS FIREP ''- Imo.' • S HOODS(Commemtai) COMPRESSORS FURNAC : RANGES DUCTS GAS SSG SETS REFRIG.SYS i'1✓MS PLUMBING BATHTUBS(or Tub/shower Combo) LAVS(Bathroom sinks) URINALS MISC(Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAIN SHOWERS WATER CLOSETS(ibile) ELECTRIC WATER •TERS 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),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. (p�� �F $1.01 NAME/TITL .X,�)f C Ji p 4.04,-IA'��- DATE (Signet re) UUU (Title) RELATIONSHIP 0 PROJECT ❑ Owner Ei/Agent ❑ Contractor ❑Architect 0 Other 0 a ° ' '. o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT BUILDING SHELL ONLY? o YES ❑NO BASIC PLAN? o YES o NO ZONING DESIGNATION CHANGE OF USE? o 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 2 of 4 k\Handouts\Permit Application