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05-105731 • RECEIVED• CITY OF .fid X tl V 2-05 0 I 0 5 / 3 1 .. Federal Way P E RM I'I � SF MF CO ME EL PL DEE F COMMUNI4DEVELOPMENT SERVICES 33325 8TH AVENUE SOUTH•PO BOX 9718 r ERA).WAY FEDE53-835-2607•FAX 253-835-2609 L,WAY,WA 98063-9718 A P P L I C A I,411 G DEPT. T .._._,,..,,.__.f__* / www.cituo((ederalwau.cum. The ollowin• is re•uired in ormation-an incom•lete a••lication will not be acce•ted. Please •rint le•ibl (in ink)or . /^ \• PROPERTY INFORMATION SITE ADDRESS 3222.5 PAc fl C I'aw y, S• Feoeso-ii,t-•1,44Y SUITE/UNIT# 1 0 5 ASSESSOR'S TAX/PARCEL# I 0 0 5' 0 - 0 1 0 0 LOT SIZE(4) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for length,'legal descriptio) ■ 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 onlu) ,MvflIY eWIS7ln1e FlizesPR\N lQ 5YSreM in) Op-oe2 TO ADI) New (2-e-Li-4S ( ..)Ot.NT PR4i'-t15-e... i-k -9S Faz Wein) TS�Ja^IT SU5PeND ce.1 tINLo A ex(T GC )CPeZ.... GE►L1Aic=, C9A5 - c cifv`arRuc-TIo.rJ ?J&VI- 05--1O531'4--Go PROJECT NAME(Name of Business or Owner Last Name) L 4 L 4-4 ANA)q)\. &Z e-Q U e- II PEOPLE INFORMATION PROPERTY NAME PRIMARY PHONE OWNER 1-9A RSG) 10\1`S?-e N`rs (So3) 21-2-2q t)O MAILING ADDRESS CITY,STATE,ZIP 17 21 5.w: StLM0N ST. "f' a-rc.A:,.c:), ce. 41'Z2-05- CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE F)RE- SPRiNK-t-Ce-S 1n.)4.• ..IFF' (4cCi ( 253) S2.10- Oag9 MAILING ADDRESS CITY,STATE,ZIP CELL PHONE 1 o)4 lv c --n-4 ST. 5LAAA eza.,(4 ( Z53) 511(a- 5ego CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER 1. 0 - 0 - I o 0 (v 3 -B L IL / 31 / o•5- (25'3) 2"249 - W33 - J /n� CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE �c/�� F \ � � S l4q v g R J )Z / 3\ / os APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE A So /i: ( ) - MAILING ADDRESS CITY,STATE,ZIP CELL PHONE ( ) RELATIONSHIP TO PROJECT FAX NUMBER 0 Architect 0 Tenant 0 Agent 0 Other(Describe) ( ) - CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS .,W-rrf" 1 ikGG)+'e-1 (253) c3'2-1.y-© I aI Jr_ffl F5)eLoriv A6T Pe LENDER vitt acw: 9 2?'UJ5 mer information is' NAME required ifpproject value exceeds$5,000 MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) - II DETAILED BUILDING INFORMATION EXISTING USE RE-(A.Ni_._ PROPOSED USE C2E7 c 1 L EXISTING ASSESSED/APPRAISED VALUE $ I VALUE OF PROPOSED WORK $ 3 Cr c2.CO SPRINKLERED BUILDING? ?!(YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? YES o NO WATER SERVICE PROVIDER LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER LAKEHAVEN 0 HIGHLINE o PRIVATE(SEPTIC) 410 • • PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST _ 1-31544L,y DEM 1 S E7 Te' -r S PAGE 143 140 4,F-, SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE ❑ CARPORT❑ _.. EXISTING PROPOSED TOTAL mralL EXISTINGsF' i'o7'AL PCfG!"O iR.Br '. TOTAL SP NUMBER OF FLOORS 1 W t1 0 4S **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. Value of Mechanica $ AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS H•►: (Commercial) WOODSTOVES BOILERS FIREPLACE • S RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE 0 PLUMBING BATHTUBS(or Tub/Shower Combo SHOWERS WATER CLOSETS MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE 0 S SUMPS RAINWATER SYST W - , MACHINES URINALS HOSE BIBBS VS(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 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. / 714i l NAME/TITLE :moi'- DATE 1 ' . I D `la ,-.4 �..J (Title) RELATIONSHIP TO PROJECT • Owner ❑ Agent Contractor ❑Architect ❑ Other FRR�'ICEIL1 a NEW o ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT BUILDING SHELL ONLY? a"YES p NO BASIC PLAN? a YES a NO ZONING DESIGNATION CHANGE OF USE? a YES a NO NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO PLATTED LOT? aYES "0 NO .:DEMO PERMIT REQUIRED? a YES" a NO Bulletin#100-January 7,2005 Page 2 of 4 k\Handouts\Permit Application