06-105769 RECEIVE
CITY OF NOV 0 8 2006 0 - / Q �"
Federal Way — — — — ��
COMMUNITY DEVELOPMENTSERVICE3 Y.OF FEDERAL�r PERMIT SF MF CO ME EL PL DE EN ' P
33325 8THAVENUE SOUTH•PO BOX 9718 ;I LD I N G OF;
FEDERAL WAY,WA 98063-9718 APPLICATION TD �
253-835-2607•FAX 253-8354 09
wwwd tyafederahva y.tom
The following is re•uired information-an income lete a••lication will not be aece•ted. Please •rint legibly in ink)or type.
,rte M PROPERTY INFORMATION
SITE ADDRESS 32.ZZ C.-C-'IC. /44!/ �.- SUITE/UNIT# /02-
ASSESSOR'S TAX/PARCEL# / a 5-0 - O // T 0 LOT SIZE(sf)
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 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detaileddescription of work included on this permit only)
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PROJECT NAME(Name of Business or Owner Last Name) --Z7,-. ^ O-‘97 •-)40a Oti .jCS
.." R PEOPLE INFORMATION
PROPERTY NAME/, PRIMARY PHONE
OWNER C2/��5 ,1.7Y `i-e/e -7?-'007 ' l�1`s51 cZyc�-
MAILING ADDRESS CI. �
TY,�STATEEZIP
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Sct 1;( Cn. , /mac . ..e.-*� � .3. c"
MAILING ADDRESS++'' /:., CITY,STATE,ZIP CELL PHONE
77,3cCITY 0 L BB SI, EN�NUMBE ez• lam% /4 . ( 3_ -6
EXPIRATION DATE FAX DUMBER
.tea-a-- z D 33 -B L /2-/, /C4 (233 5/- 45:0:)
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
J l 7Z C--7 .-E' s ' 2,Z .1 A, /7--/ /OW -
APPLICANT COMPANY NAME AP LICANT NAME
SG` OFFICE PHONE -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT 1 FAX NUMB ER
❑ Architect ❑ Tenant o Agent Other(Describe)Cr Z3►C'/GY" -
CONTACT NAME PRIMARY PHONE EMAIL ADDRESS
LENDER NAME
MAILING ADDRESS CITY,STATE,ZIP (HONE
IP ) -
cit ■.DETAILED BUILDING INFORMATION ,;;;
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $_
SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
: WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
0 •
,.. .. ,... , .. . 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 0 CARPORT 0
RJUSTDDI PROPOSED TOTAL to ,.7 ' 4P',124 �;'t44: 'Y fg „i',4 5
NUMBER OF FLOORS ' �,s ,, f,> �' K,.,v s: '� , r :9V--',44/0'.'3',..,'i,•:-,-1
**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(commercioi) 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 rroiot) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(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 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 arty 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.
NAME/TITI _ (Title) DATE
.../".c/e/c36
(Signature(
RELATIONSHIP TO PROJECT CI Owner 0 Agent Contractor 0 Architect 0 Other
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