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06-104698 , .10.- - , CIT'OF i�ECE D . C - l o ccb g s Federal Way PERMIT COMMUNITYDEVELOPMENTSERVICES SEP 1 5 2.006 SF MF CO ME EL PL DE EN(6) 33325 8"AVENUE SOUTH•PO BOX 9718 I ' I L I C A T I O N TD FEDERAL WAY,WA 98063-9718 253-835-2607•FAX 253-835-260 ITY OF FERE www.c,ioffederalway.com BUILDING DEPT. The oIlowin. is re•uired in ormation-art incom.lete a.•Iication will not be acce•ted. Please •rint le•ibi (in in or .e. •.- ;: • -- III PROPERTY nINFORMATION . • SITE ADDRESS 3/ 16 2F77-1 Ave' .5 Ft 9t/2#)I/ LJAy SUITE/UNIT# ASSESSOR'S TAX`/PARCEL# 0 9 2 / 0 _•y - ? 5 / LOT SIZE(sj) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal description) ■ PROJECT INFORMATION -- .- _-, .,_-.--,., ..-. ,.-- TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING leFIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu) insia/a-1/o,i or 0 ,1e1.V S/Qy,, /e/ S1ei-rn pe/ ,%e,o, /3 R PROJECT NAME(Name of Business or Owner Last Name) Y//zA t•sPE/P/14/Z4 . U PEOPLE'INFORMATION PROPERTY NAME PRIMARY PHONE OWNER ✓/LLA L-sWE,'4/v24 2L e 1 ( 204) '.qd 1 - lisp MAILING ADDRESS CITY,STATE,ZIP slog 5 t1/Ya'Ec//1/E -5 SE/ine 1,4 98//S CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE A,V4/4 4/1.4-g f "XVIECT/on/ Folli/buil Ali/iar/ (Sits) 4,83 -5415-7 MAILING ADDRESS CITY,STATE,ZIP CELL PHONE /7731 /4/1/7// 4VL Ni k/00©/4/r/e1E E464 981.)/Z ( ) - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER 1 y-.$' L- QQ QQQ7- B L /2 / 3/ / 06 ( ) - CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application( EXPIRATION DATE /4 D v a N f e l :2 9 e 6 o5 / O/ / O7 l APPLICANT COMPANY NAMEAPPLICANT NAME , OFFICE PHONE Se.i'ine �rinie_ ( ) _ MAILING ADDRESS CITY,STATE,ZIP - CELL PHONE ( ) - RELATIONSHIP TO PROJECT ��77 FAX NUMBER ❑ Architect 0 Tenant 0 Agent jOther(Describe) d/esiy)« ( ) - CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS ip a�I7a/ ► M;lfa,► (125 ) x/83 - s637 61 /7 ad✓<Ve e isctyr ,a.£er, LENDER C;g'". niter i rri atlon s NAME r. ire if pre ua ue ee• 5,000 ,,.1 MAILING ADDRESS CITY,STATE,ZIP . • .. .. : •: . • DETAILED BUILDING,INFORMATION - . . . n EXISTING USE PROPOSED USE A /1•nei1'S EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ ;'3 72 3 SPRINKLERED BUILDING? v'YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) PROJECT FLOOR AREAS I *oW.,..Das^^• ..O��^ • EXISTING =•OPOSED TOTAL SQ.FT. SQ.FT. SQ. FT. BASEMENT FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) / NNNN%""•...„..................:: ............__ DECK(COVERED?) GARAGE 0 CARPORT 0 EXISTING PROPO tot,u. .. .0',;T,..,f.]GXIB'RPO SP-mays. *Ro �SP TOTAL 8t NUMBER OF FLOORS '.; tVa , .,>.>.ig .:: 'u: *n' . M **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 4 HOODS(commcrci i) WOODSTOVES BOILERS FIREPLACE I ERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTL PLUMBING BATHTUBS(or Tub/ShouerCombo) SHOWEr WATER CLOSETS(mile) MISC(Describe) DISHWASHERS SINK / DRINKING FOUNTAINS GAS PIPE OUTLETS S PS '• NWATER SYST WASHING MACHINES ALS HO = BIIBB LAVS.(Bathroom sinks) VACUUM BREAKERS ELECTRI`Er 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. D / et(i f Mpt_,X1 f� NAME/TITLE Al-h` ''tc""I'l k �+ DATE (Signature) (Title) RELATIONSHIP TO PROJECT ❑ Owner XAgent ❑ tractor ❑ Architect ❑ Other OFFiG [ EW 'I) TION •" TERATION n .�rR X'IR, .TENANT-IMPROVEMENT' a giB � 74• .x � } 1 .+..: *-.,4v e.�4,t '`k ix ,,4M-o Y' ;e .f7 N0 *. i.„---'.........,—,--,7—,..:.-;,:-G F .ONLY . Y a p - - '' �. ,,,,G" �lN? s', 11 G,P, S19, rt 'x HAINGE RNSE?-g. ,�-' a ,' yo YES'ate,-c:•t O ,,7ANIIIG,�ESI�NATJ,,ON� , �. F _�; ��� � ��t 'W ARS.... UIRE,D? : YES aO '' Ct "EM'` �O /RMITUIRED� `, 2 - 7- O � . , .Nv, 1, /SEPASU ,P � = iF3 R+ED,.-• 't � ' ��� ; , ',•, ' ,,, teT�� FS7" rU .Fr '`i Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application