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06-102600 O411 CITY OF MAY 2 4 �� - 6 - l D t bo 7 Federal Way vRMIT 1� \ COMMUNITY DEVELOPMENT SERVICES CC r� a, SF MF CO ME EL PL DEE FP 33325 8TH AVENUE SOUTH•PO BOX 97trry qOF�rF��ml i LI CATI O N FEDERAL WAY.WA 98063-9718 YUI1..MIN TD / / 253-835-2607•FAX 253-835-2609 CLOW.t atroj;cdernitcart torn The ollowin, is re•uired in ormation-an incom'lete a,'lication will not be acce.ted. Please ,rint le.ibl (in ink)or t ,e. �7 (� • PROPERTY INFORMATION SITE ADDRESS 72Q 5 7 (Act Fic 14,0* S SUITE/UNIT# ASSESSOR'S TAX/PARCEL# I 5- 0 0 5 0 - 0 I I 0 LOT SIZE(sf) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal description) • PROJECT INFORMATION TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ®'FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit oniu) ,/ NGj:II•Lc. it CE S P21.vIL Lk-ZsF Nifty CA,nt 019 y,, C+JT t N N'Ew (s?)+4 M(E-ca. 'FEZ i N,e.A., 411 ba-sf kiAw't Sao 'u.,,) jiJ .> 4" &u.iz Feet. Theo '1p)mccufljg-a 1€Na.NT e- P4ee . PROJECT NAME(Name of Business or Owner Last Name) eci. 4-Tl®n) s updJj BLPw c= 1 CANoel i-riPoE A • PEOPLE INFORMATION PROPERTYNAME PRIMARY PHONE OWNER �'4�LSCik `:tJ ve.5.r M ,4;5 ( ) - MAILING ADDRESS CITY,STATE,ZIP Pv 60JC 1;"1° 51201Z-TLAPJp Oe- 97eOB CONTRACTOR COMPANYOMNAME APPLICANT NAME OFFICE PHONE t..,2E Spit,A) ces 'Lk. .-fc.f. (2 3) 8z4 - cic91 MAILING ADDRESS CITY,STATE,ZIP CELL PHONE tO\or 1\IuA_Tw. ST * 41A)R.,2 In)A q ago (' ) - CITY OF FEDERAL WAY BUSINEAS LICENSE NUMBER EXPIRATION DATE FAX NUMBER Z O— () — 1 0 0 (0 3 - B L / / (ZY3 )Sze - k033 CONTRACTOR'S REGISTRATION NUMBER� (copy of card required� with each application) EXPIRATION DATE it 4 l p lr` ( j/ /0 APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE �-�-.fin MAILING ADDRESS )41„. � ( ) ITY,STATE,ZIP CELL PHONE 111 111 ( ) - RELATIONSHIP TO PROJECT FAX NUMBER 0 Architect ❑ Tenant ❑Agent Other(Describe) Co Q'11 . ( ) - CONTACTNAME PRIMARY PHONE E-MAIL ADDRESS %_'4 t-F� 6A 22o tv ( 25-3 ) 3 ) $'Lt., - 00`i 9 LENDERPer RCW 19.2-7.095: Lender:i>rlformation is NAME required if project value exceeds$5,000 MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) - • DETAILED BUILDING INFORMATION EXISTING USE CA IPOPLA PROPOSED USE ellooP 1 EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ Z 7, 3oo SPRINKLERED BUILDING? YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? TES o NO WATER SERVICE PROVIDER EHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) • fill 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 ❑ CARPORT❑ NUMBER OF FLOORS EXISTING PROPOSED Tot TOTAL sxisrmn sr Toa wv rnoeosao sr TOTAL$e **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(commercial) 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(Toilet) 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 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'Z _ DATE e--/C3 �P (Signature) (Title) RELATIONSHIP I PROJECT 0 Owner 0 Agent Xontractor ❑Architect 0 Other FOR OFFICE USE ONLY o NEW a ADDITION a ALTERATION a REPAIR ©TENANT IMPROVEMENT BUILDING SHELL ONLY? o YES a NO BASIC PLAN? ❑YES a NO ZONING DESIGNATION CHANGE OF USE?' a YES ❑NO NEW ADDRESS REQUIRED? o YES a NO : UP/SEPA/SU? a YES o NO PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application