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07-103019 1 JUN 0 47 CITY OF ,„„,_A. CITY OF FEDERAL z' 0 ' - 0 �. _� Federal Way BUILDING D AL I/ RMIT *moi^� COMMUNITY DEVELOPMENT SERVICES SF' MF CO ME EL PL DE EtV�, P r J 3332E FEDERAL R WA SOUTH•PO 639OX 718 APPLICATION CATION ����� 53-835 07Y.FAX 53-8 3-260 L 1 / / - 253-835-2607•FAX 253-835-2609 www.cituoffecleraIwau.com The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type. • PROPERTY INFORMATION SITE ADDRESS 3.36/5' /s1 vV' So✓M SUITE/UNIT# I ASSESSOR'S TAX/PARCEL# 9 2 ( 5 0 Y - 0 1 / 0 LOT SIZE(sf) y3 c$7 LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal description) Ni PROJECT INFORMATION TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL \/ ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING,�J FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) 1 4rxp44/4 . 1/G'r S�/t/�VALcry( 70 C��P1...,--i-z- ss- ,--ate! .w�cov - . 4. Zr4Cc-v4/,(� lr-4/57%4/4 .�av4 re;f/A4,7' ft C)/Z/v6 TA/jitju4At Ci2&oy PROJECT NAME(Name of Business or Owner Last Name) � /� ©, c Ler i?1-'iC7i_''- • PEOPLE INFORMATION PROPERTY NAME PRIMARY PHONE OWNER .SLS/(/ 77� (ZG'4 ) ale - 32O/ MAILING ADDRESS CITY-STATE.ZIP E-MAIL ADDRESS /-57 544 44�D Z sr/Zc r#A S�.4Z-1-6f 11A. 7e/3 y ' CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE # 'gef SYsrzm c i/esr C44/4 ,tel/cctc t (25 ) &33 -/zy'e MAILIN AD RES CITY,STATE,ZIP CELL PHONE 2 ,34/r46C i(_ A) . ,off STATE/, vt)f 990V'? F(AX CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER /9-87-ovoo/S'-cn13L fz-- -v-i ( ) - corr of Cara required CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS with each application I /'°/Q 4r 5t11/ /yO,c$/ lv-07 APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE ,o?, ' -St:5174-045 (�I/c7-- C4'4/4 Al//.c./ ( ) - MAII,ING ADDRESSCITY,STATE,ZIP CELL PHONE BN 2/q r 4 —4c �l. �G/ i3 t ,4A 8o9-7 ( ) _ RELATIONSHIP TO PROJECT J FAX NUMBER ❑Architect ❑Tenant .Agent ❑ Other ( ) - PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS CONTACT -ed/4 /t- ' (2Si ) $33 - /Z416' LENDER NAME PerPGW 19.27.0 6,7____i4LTOR •nder inform on is quired if p oject `,lue exceed . 000 AD a• S'. - CITY,SAATE,ZIP PH q E / 1 • DETAILED BUILDING INFORMATION EXISTING USE 0/t/.V4 L' PROPOSED USE a" /C&' EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 9C ole•'"' SPRINKLERED BUILDING? YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ItYES 0 NO WATER SERVICE PROVIDER acLAKEHAVEN 0 HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER o LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) a. • PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST SECOND THIRD ADDITIONAL FLOORS(DESCRIBE) DECK(❑COVERED OR ❑UNCOVERED?) GARAGE ❑ CARPORT ❑ EXISTING PRo ..0, TOTAL TOTAL EXISTING TOTAL PROPOSED SF TOTAL SF NUMBER OF FLOORS F **NEW HOMES ONLY** NUMBER OF BEDOMS 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$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION AIR HANDLING UNITS EVARRATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES BBQS FANS GAS WATER HEATERS MISC(Describe) BOILERS FIREPLACC,INSEI HOODS(commercial) COMPRESSORS FURNACES' RANGES DUClb GAS LOG SV' `', REFRIG.SYSTEMS PLUMBING 7' BATHTUBS .�VS(Bathroom Sinks)(or'[Ub/Shower Combo) URINALS MISC(Describe) DISHWASHERS 'RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSElb(Tottery ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBBS SUMPS SIGNATURE 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. 1 NAME/TITLE «.r/. 4/G �C �Gv�``/ ` DATE / r (Signature) (Title) RELATIONSHIP TO PROJECT 0 Owner 0 Agent XContractor 0 Architect ❑ Other +OR1(? IGIM yrs'.. 61.1!'11L Xr :1 ❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT BUILDING SHELL ONLY? o YES ❑NO BASIC PLAN? o YES o NO ZONING DESIGNATION CHANGE OF USE? ❑YES o NO NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? o YES ❑NO PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? ❑YES ❑NO Bulletin#100-April 2,2007 Page 2 of 4 k\Handouts\Permit Application A