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06-100589 Iry • • - L0052 ' co r DEWCES ay PERMIT o z►� VELOPMENT SERVIMFCOMEELPLDEEFPI 33325 m NUE SOUFEDERAL WAY,WA 0 9978 88063 88ClCI Y FEp � ^, aY 253-835-2607•FAX 253-835-2609 APPLI CATI SING DE* www,ctuoffederalwau.com The , is , ired' -an' .-, , ,y,IiCatiOlt Will not be , " ,ted. Please , ' t , _ an ink)Or _j, . • PROPERTY/ � INFORMATION / - /10.-.46--- SITE ADDRESS �,P..?...?-,-.S----i.., ,,,,,‘,C M' a y'sOdl4SUITE/UNIT# /�� ASSESSOR'S TAX/PARCEL# / 0 6 Q - O / O O LOT SIZE(sJ) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) tAttach Page fix lewd deso4.on) • PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERINGjFIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of uvrk included on this permit onlu) / . Ad i S -Sy -✓ e t�. ill PROJECT NAME(Name of Business or Owner Last Name) A014/421-/4P7 i. " U.e • PEOPLE INFORMATION PROPERTY NAME �� �� PRIMARY PHONE OWNER ✓.,5'G A _zj-'(A.056->t P��14O'a'/�-Pd/i'`ef )b'Z'{x, - fepli MAILING ADDRESS CM:, ATE,//2/ s, s/�'t 5,47, /71/4V 17 '"t 4• ?7 s-- CONTRACTOR COMPANY NAME APPLICANT NAM$ OFFICE PHONE MAILING ADDRESS • CITY,STATE,ZIP CELL PHONE /7....'© l7, S2o.1 /8 p , ✓ter-e/' di. ? z ( — CITY OF FEDERAL WAY BUSINESS LICENSE NUMBEREXl DATE_ FAX NUMBER Vidtri.s757 "41.5-4 CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE APPLICANT COMPANY NAME ( APPLICANT NAZIE OFFICE PHONE %G �ld G,io•i, .J's�-r6 �70c0'3. __(,...7.00":4, (c'i - ;2.i'l, Q6.o MAILING ADDRESS / CITY,STATE,ZIP CELL PHONE /7�O G'i,� �it sae, t%,G rr/Aff / )f (.-..--). RELATIONSHIP TO PROJECT FAX NUMBER 0 Architect o Tenant {( Agent 0 Other(Describe) (4 \31 !3 -1-15W CONTACT NAME PRIMARY PHONEE- ADDi i.S ec).7-e " ( l6 - Ilio. -< , d avi,. s�F,, , LENDER [I9 3aldrnv +�.... N / a reoutred3f�ltitectoal, -excaeds._$iS,000 �,�f// MAILING ADDRESS CITY,STATE,ZIP PHONE • DETAILED BUILDING INFORMATION EXISTING USE f /r�L- '- / PROPOSED USE .rr AV 4 EXISTING ASSESSED/APPRAISED VALUE $ �./.7d VALUE OF PROPOSED WORK $ -,/U/.�' --- SPRINKLERED BUILDING? YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES ❑NO WATER SERVICE PROVIDER o LAKEHAVEN o HIGHLINE 0 TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) • • PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST c7S-4 SECOND THIRD FOURTH e„..-- ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE ❑ CARPORT 0ICUSIING NUMBER OF FLOORS �"O/'� � ' � o •"NEW HOMES ONLY" NUMBER OF BEDROOMS( ESTIMATED SELLING PRICE $ FIXTURES Indicate number of each type offixtrire to be installed or relocated as part of this project. Do not include existing fixtures to remain. MECHANICAL Value of Mechanical Work $ AIR HANDING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOODS WOODSTOVES BOILERS FIREPLACE INSZ Ktb RANGES }� MISC(Describe) COMPRESSORS FURNACES GAS WAIIG(HEATERS / DUCTS GAS PIPE OUTLETS . Sryp�j _'� �f PLUMBING ;,�, ,fly BATHTUBS(or n v/Shower Combo) SHOWERS WATER CLOSETS nmiet) MISC(Desctibe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS(Satbmov,Enke) VACUUM BREAKERS ELECTRIC WATER HEATERS DISCLAIMER/SIGNATURE BLOCK I l wader penalty of perjury that the Information furnished by me is true and correct to the best of my knowledge,and feather,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 Flederal Way as to any claim(including casts,expenses,and at s'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/,bat only where such claim arises out of the reliance of the city,incl its o employees,upon the accuracy of the injbrmation supplied to the city as a part of this application. NAME/TI —( DATE c?-/T/b‘ (Signature) retie) RELATIONSHIP TO PROJECT o Owner o Agent > plractnr o Architect o Other a HEW '' ©ADDITION a ALTERATION o REPAIfi=..'; n TEN T` BUILDING-SHELL L"ONLY? ,._. '__a. S:;n.31lO -BABIiCP.LAN4 ZONING GESIGIITATION CHANGE OF USE? ADDRESS REQUIRED? a YES i, o NO NO LATIED OT? fl YES"'a YO"` DEMO-PERMIT ED? - n YES kWatedouts�Pennit Application Bulletin#100—January 7,2005 Page 2 of 4