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07-106129 �"�/' • aTY OF iF`e...(/�_EiV . Federal Way PERMIT ,D .3- C° � COMMUNITY DEVELOPMEIYT SERVICES 8 2007 SF MF CO ME EL PL DE EN FP 33325 8TM R SOUTH•Po 9 9718 p p L I C AT I O N FEDERAL L WAY, WA 98063-97]71 8 rp 253-835-2607•FAX2S3-835-2609L DERALWA / /.--�� I www.eityo/fetferalwau.com AC DEPT. The ollowin. is re•uired in ormation-an inco 'fete a.•lication will not be acce•ted. Please .Tint le•ibi in i or Cc �1 ■ PROPERTY INFORMATION r SITE ADDRESS I V Z� 3 d�V ��" 51SUITE/UNIT# ASSESSOR'S TAX/PARCEL# 0 9 9- 1 0 II - 1 0 4,5 LOT SIZE(sJ) 2 2,36 9 LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) Ds W Shp e, (Attach separate page for lengthy legal desaiption) • I. PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION D ELECTRICAL 0 ENGINEERING„R FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) 1 � N . :� ►;•e.�n t4.-4- { DS i..,1 S ke . Plu * c p,-,� i k it-vs., .104-cbcYex,5 1_,,,ti, u p,1 u F Pk-r) Ve ,ft PROJECT NAME(Name of Business or Owner Last Name) D L,;' :I)i t ie c .• - • PEOPLE INFORMATION PROPERTY NAME PRIMARY PHONE OWNER 5e-k—Tk. . 1/:Iledt. r5 ko ,'j. Lent e„r i%1.-C_ ( ) - MAILING ADDRESS �� ° CITY,STATE,ZIP % I SI,J 6;„ ✓/-e Su IC l3co ('or"Ad) 6Yp 0,A CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE n, tje..- -t—rh 5 1-es Fre (�rofear-011 Aocirew Glaa4c 4.i1w- (LIZ S) I'S' I -oic L' �°,'`iMAILING ADDRESS CITY,STATE,ZIP CELL PHONE lit ata z 1 SOP4' Alit _,,VE S,.r/e 4-/o 5' Redt,.o..�, 1,,A 49©5-2 (,1 z —)33 6` - 22 3 CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER I EXPIRATION DATE - FAX NUMBER \\�� CONTRACTOR'S REGISTRATIONNUMBER(copy 6- B L (1 /3 / © 7 (1(2 S ) 3d 30 of card required with each application) EXPIRATION DATE L) ESTf— SF1 3662F 0 / (1 /01 APPLICANT COMPANY NAME - APPLICANT NAME f' OFFICE PHPHONELi e 4-e,,,,,4-e,,,,, 5.4 is l=,-rt A.,,) o ci:4�,., ,..4,/,e,, L-kt::.wt:atL.- ('V-S ) c1 D I -0lo-c MAILING ADDRESS CITY,STATE,ZIP CELL PHONE 7wi /`6C.1- s e. il/r 5'u7A-(d S' rte 4,th Jiii/4 4i6d5L (17-c- 1 736 - 2231 RELATIONSHIP TO PROJECT FAX NUMBER ❑ Architect 0 Tenant ❑Agent 0 Other(Describe) (i(Z r) 5$ / - 30.jG CONTACT NAME �VrCW / ' �.q,uly@I�b`r PRIMARY PHONE E-MAIL ADDRESS"� LENDER =tea r ay AMES 1 't 3 - LZ ) anu�rCu.v�tcvw�u 110,6;lJ 5(�us a MAILING ADDRESS CITY,STATE,ZIP . • . • ■ DETAILED BUILDING INFORMATION • EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ .6 , 7 7®„co SPRINKLERED BUILDING? a YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES 0 NO WATER SERVICE PROVIDER ❑ LAKEHAVEN a HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN a HIGHLINE 0 PRIVATE(SEPTIC) -} PROJECT FLOOR AREAS `U..rl AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ. FT. SQ.FT. BASEMENT FIRST SECOND THIRD • FOURTH ADDITIONAL FLOORS(DESCRIBE) • DECK(COVERED?) GARAGE 0 CARPORT 0 NUMBER OF FLOORS EXISTINGPROPOSED TOTAL r t4YL7asruPo,srs € xuru PROPo3wSF . --v TOTALai r **NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ FIXTURES Indicate number of each type of future 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(comm,rciali WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS(or h,h/snewerCombo) SHOWERS WATER CLOSETS(rode) MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS(Bathroom sem( 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 fu ther 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 l rt e.,‘,1 1�,Lt+ DATE C +,ZC( C; F (Signat e)R (Title) ' RELATIONSHIP TO PROJECT 0 Owner 0 Agent ❑ Contractor 0 Architect ❑ Other '�a� -.-----r7.-. '`"' � ,.,,,„:4,-,,.-v P'+°�a- 3. '�'*x x ^^r ret: r % ,,,. / 1. .- �� „Mal ' i ® .`te r. a 3x ti-1-i-,"-"�d "-i '''a i$ �w a x: ® j e,® ... -,v, ' 3 ,� ` �fi " mo w. t �sw -1,7-'24106 D 7�D C III• D < '"'® ox'-7-10,,,i.�� ,� r hUP SEP SIJ ' x D. J a. NO { 1 J_• ,z<.. e <r� tv {a.. a?. n>-. F y�1� ��M1-.., P..,.DO 0 11�� : taE' ;77,77- ':'. (] 'ai Bulletin#100-January 7,2005 Page 2 of 4 k\Handouts\Permit Application