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06-101584 reed' !!)(L - 10 iZq �'edewa ' �.:, EIVD PERMIT • COMMJNITYDEVMMOFMSM'SERVICEs SF MF CO ME EL PL DEE FP 333€ w 97182006 APPLICATION TD / 253 835 2607•FAX 253-135-2609 / / e wuntheituoffederalwau.cogi !! CITY OF FEDERALWAY T e allow' = t ". ilermation-an inco •lete a••lication will not be acre•ted. Please •rint legibly n in or ty• . 1 ■ PROPERTY INFORMATION/ SITE ADDRESS 3 g e pl cr.- � -r /G� f cry JL) ` " Jo C SUITE/UNIT# ASSESSOR'S TAX/PARCEL# - _ _. LOT SIZE(sf) • LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) Finada seParalePageftrMieelacriaideaaipdcni ■' 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 permit only) ,o,`76 /•='/')tcam r(I fs/Ls SY,S%�-t� ,�r LL / ,�,-c Lr Civ lieu v • ^ ly/�/.v I PROJECT NAME(Name of Business or Owner Last Name) 4 L it) r.. L3,9,P 4 r=cu • PEOPLE INFORMATION PROPERTY NAME L' ,, j`� /, PRIMARY E OWNER r / G`Jak5cV 1. MAILING ADDRESS CITY,STATE,ZIP CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE V443k't Yl e - e IR (rZ7-1/0'edkr :rb -6 v 53. IM 0 ADDRESS 'CITY,STATE,ZIP CELL PHONE 6--Q mac 3e a (9of) Esti-Go s"s CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER / EXPIRATION DATE FAX NUMBER B L . / / 1 0 7 ( ' i3 . CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE 1 Ll of,4Pr6 iS ,-122 / i / l07 APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE Vit34 is J/'76 K &j c — Gcvk-etc-G 7-1 u6-r/t-(1N (.2�C ) 6(7 C d rS MAILING ADDRESS CITY,STATE,ZIP CELL PHONE e 0 -/6601, o?636T" (.2,14. ) Ga -co RELATIONSHIP TO PROJECT / FAX NUMBER 0 Architect ❑`Tenant IPAgent ❑ Other(Describe) (Z/�t 61 3,y - //3( CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS :�� �5- 61(1..)6c0 - 4.0 5--1- LENDER :3 r 3, �a i <Y7 z F=;iiz x NAME MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) Ill DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $3, A/c—CV cs SPRINKLERED BUILDING? D YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN . ❑ HIGHLINE ❑ PRIVATE(SEPTIC) • 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 �:- 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 $ AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOODS(commerc1 1) WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING • BATHTUBS(or7ub/shower Combo) SHOWERS WATER CLOSETS crones MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAYS(Bathroom stale 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 authorised 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. NAME/TITLE / DATE 3 ri/ -,?z'6 6 (Si ature( (Title) RELATIONSHIP TO PROJECT Q Owner 0 Agent R Contractor 0 Architect O Other • in ay r,) 51 :. ? ��,f9Fa�V a` �'^" 4 �; 1 e,S., ;7;,°,# ":1 � ',; 3,,'3 i3L 3 1y,1 3.,33 w'1 1.'*"( SA ID ¢ � r� 1W.,z ���. . � � ,r A �,14 ;(1 z© 0l i .;". 43(33.,, Inir '',31333.)30%''.1 0yi V f ,t3 ts' '13333n3.' Bulletin Bulletin#100—January 1,2006 Page 2 of 4 k\Handouts\Pennit Application