08-105584 A. • .0
unoF RECEI V L�,,. - / O �
Feral Way PERMIT —
COMMUMTYDEVELOPMENrSERVICES `iv 1 9 200?
SF MF CO ME EL PL DE EN... ")
33375 gni 253-835-2607.AL WAY,WA
09 SOUTH•PO BOX 718
FEDERAL WAY,FAX
98063-260 TD / /
wwW.city°ffederalwat.com rY OF FEDERi
The o llowin. is re.uired in torntation-an Inco •fete a•.lication will not be acce.ted. Please •rint le.ibl in in or
•1111PROPERTY INFORMATION .
3�o�90 rt `
SITE ADDRESS � Ave- J SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 7- , - 0 ti - /, 0 3 7 LOT SIZE(s)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
M PROJECT INFORMATION -
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING El FIRE PREVENTION SYSTEM
T
PROJECT DESCRIPTION//(Provide detailed description of work includedu {on this permit onlu) ,
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PROJECT NAME(Name of Business or Owner Last Name) I Ou 0 G/ct 1- U i1 HO LLS e -
• PEOPLE INFORMATION •
OWNER
PROPERTY NAIVE ` Otit(' c/P.I.t, !.�
PRIMARY PHONE
/) I
MAILING ADDRESS 2( CITY,STATE,ZIP -
CONTRACTOR COMPANY NAME LL APPLICANT NAME I OFFICE PHONEp� o
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MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
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CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE -- FAX NUMBER
— _i- 6 L-L. S2 b W Z 6 -B L IZ- (31 (0`6 (ija51 , - 30
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application( EXPIRATION DATE i
W G s ' tr S F 3 0 E / / 0e6
APPLICANT COMPANY NAME f ✓f APPLICANT NAME i 1 OFFICE PHONE
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MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
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RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect 0 Tenant ❑Agent ❑ Other(Describe) '--:14.1,"(k.- PM (,1;... ) ef' ( _303 0
CONTACT NAME PRIMARY PHONE
1 w �? E-MAIL ADDRESS
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LENDER ' .01!''/l-%ts .rl` �itti i.:F- NAME
MAILING ADDRESS CITY,STATE,ZIP
• • . . - . In DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
I
\'� PROJECT FLOOR AREAS �l',
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT 0
•NUMBER OF FLOORS EXISTING PROPOSED rornL I TOTAL55Q a-ss'r * .a SOTALPROPOSEDN ¢s -"^ TOTAL Sr ri
ll
**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 fvdures 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(moot) 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 relic e ofci i •'udi Its officers and employees,u on the accuracyp j
this application. � f� p of the information supplied to the city as a art o
NAME/TITLE / ��" ' y�e./ 1lan DATE I// /e)
(Signature) the / `
i (T l:
RELATIONSHIP TO PROJECT 0 Owner 0 Agent B Contractor ❑ Architect "Other
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Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application