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06-100887 RECEIVE Federal Way PERMIT FEB 2 7 200p - _0 _O 13 PERMIT SF MF CO ME EL PL DE E �� COMMUNITY DEVELOPMENT SERVICES 33325 D AVENUE.WA 9•63 BOX 9718 AP P LI CAT!' FEDERAL WAV.FAX 98063-260 E D E RAL .7- 253-835-2607* 253.835-2607•FAX253-835-2609 L 1NG LIEP www.cituoffederalwau.com The ollowin! is re•uired in ormation-an incom'tete • •,lication will not be acce,ted. Please •rint le,ibl (in ink)or . (� • PROPERTY INFORMATION SITE ADDRESS 3��25 P( .e.:I f,P 1-16, 5 SUITE/UNIT# I 05 ASSESSOR'S TAX/PARCEL# I S 0 0 5 0 - 0 1 d Q LOT SIZE(sfi 36) 5 LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) CM�b r k w.)n Sq,Gu re_ (Attach separate page for lengthy legal description) • PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING till FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu) AC) (3--11 c. Ce,locc +e Fire_ Sp r:nh .r herds cor fel....-1 u0c,i-l\ e.nd CeW,' naN i n n -Ti PROJECT NAME(Name of Business or Owner Last Name) L S L ( i - A-cWa.r). l C M°,c:LA._ • PEOPLE INFORMATION PROPERTY NAME PRIMARY PHONE OWNER L &1_ Hai. &i ia,nicreiszziALism.,5,zii, (B�) 3' GC��L� _ 1.{,/t_..MAILING ADDRESS Bost, / ._ - r(JLrt» S' � ld/ /GG gni CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE Are-lner Cpn.3{'f ur,.i-.onln�. Cho. r,ee Ga.11Ant (x,53 )S1 7aaa MAILING ADDRESS CITY,STATE,ZIP CELL PHONE 7355' 5aAc. ' 5f hen+, c4)c,.. igc. a ( ) - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER a 4 -8 (1- 1 o f q b 3 - B L la:/31 /06 04-3 )t-M, -7�a3- CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE A g C H. € 1 4. 2 1 112 11 oil /a I /Aoo7 APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE Arale r [.0n5'-r(A-(,,{.;jt xnc Ck nce G0410jt ( 53 ) 87 -7,2),)- MAILING ADDRESS CITY,STATE,ZIP CELL PHONE 7$55 S X2)6}k 54- Ment/ (Jo.9..to3a ( ) - RELATIONSHIP TO PROJECT FAX NUMBER 0 Architect 0 Tenant o Agent I1 Other(Describe)Fir ' fpr:nkkl CgAtvxa{ ( ).1 3 ) 1173. -7X77 CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS C'hc4.fl e- C t tt.J%+ ()53 )879. -79,aa c. t,ce.@aroAerceis+nK.f.m.4.447 LENDER ,,?,-;,,° II i d,o 8 MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) - • DETAILED BUILDING INFORMATION air�� EXISTING USE AMMPROPOSED USE /_�L_. EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ i q SPRINKLERED BUILDING? "(YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ) ""' 0 NO WATER SERVICE PROVIDER LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC) -- 411 I PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL Sg.F T. Sg.F T. Sq.FT, BASEMENT FIRST `'©U�.�h ^}'e.{�.fl �5" 7� SECOND) THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE 0 CARPORT 0 NUMBER OF FLOORS =sun PROPOSED mrni �� "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. MI -• ., GAL Value of Me icai Work $ AIR HANDLING U` EVAPORATIVE COOLERS GAS LOGS RIG.SYSTEMS BBQS FANS HOODS(comme. WOODSTOVES BOILERS IREPLACE INSERTS -' MISC(Describe) COMPRESSORS FU' GAS WATER HEATERS DUCTS GAS PIPE OUTL PLUMBING BATHTUBS(or IUb/shower combo) SHOWERS WATER C�• �A (roneU MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAI GAS PIPE OUTL) lb SUMPS RAINWATER SYST WASHING i ''INES URINALS HOSE BIBBS (Bathroom st.,ics) 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 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 �i�` %V ��`�:� DATE ` �6 (Signature) (Title) RELATIONSHIP TO PROJECT ❑ Owner ❑Agent QQ Contractor ❑Architect ❑ Other • .�'� ...� i e & a�. 1• rr �. v '�� ski `� 9 �� reftt , ,11 1iPi > °: F \..•: ��\� ry G0F V $ -r • ,ray E� :,. �� ...a, s„iicL, a .�,„mfr,ti.....�., Bulletin#100—January 1,2006 Page 2 of 4 k\Handouts\Permit Application