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07-106696 RECEV • • CITY OF ,r — C O LL L q G Federal Way PERMIT ? ?nu MF CO ME EL PL DE EN P COMMUNITY DEVELOPMENT SERVICESQ E C 33325 8TM FEDERAL AVENUE SOUTH•PO 9BOX 718 9718 �p p L I C AT I O N FEDERAL WAY,WA 98063-9718 TD / / 253-835-2607•FAX 253-835-2609(Y OF FEDERI wwta.cityo(federatway.com BUILDING DEE-i. The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type. 1 • PROPERTY INFORMATION t SITE ADDRESS ��— "?7 /(� I • SUITE/UNIT# ASSESSOR'S TAX/PARCEL# © 9 2-i 0 �- 9 © ca LOT SIZE (s) ' LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) '441"J --1--- A 16-1y (Attach separate page for lengthy legal description) • PROJECT INFORMATION TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 0 MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL 0 ENGINEERING FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit onit)) A170 l RELDC - 5jg-1 Nei % TE14 ir1_. 61M 62-0\ aw'. tTs T . PROJECT NAME(Name of Business or Owner Last Name) 'F*C".'' El PEOPLE INFORMATION PROPERTY NAME + PRIMARY PHONE OWNER 5 'T�tC V�L LA e Cr z-. 11L t. (4Z5-)'7-2 4 -5- 5-7...._, MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS tX24- s '3 D' 5T- - +__ w/y, 6vr'i CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE fl Pte_ e21/ h' LV T jp 1z-4-ARV, tz )f3, 124 MAILING ADDRESSC STATE,ZIP CELL PHONE 2\(2\ 0 0.-PA' > Ni (/4.0 c v../A- e g --1 ( -. ) 2-0'2_ 10\ CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER `2-.1ieett 't S1--C("'C'p14--cio-- L.- tZ i (25-3) _`�T� -- o COPY of card required CONTRACTOR'S REGISTRATION NUMBER,{Fe� 6■ EXPIRA ON DATE E-MAIL ADDRESS with each application I > '1CJ rfe-'�7�,V� 4 w o,O \ k o I `T,-)09 / _01&� ,-- ems_i j,f.2 i vl- APPLICANT COMPANY NAME LH"7 APPLICANT NAME �C� OFFICE PHONEN ,�/LJ•`�jY,� �G�7 � FJ 'y''1evi w, //vC ; tom% (nor) t;35- 146 MAILING ADDRESS CITY,STATE,ZIP CELL PHONE -L 14 C,E zp fr+U c( witF- eifiO4 t (253 )•Zo'z._-101,1 RELATIONSHIP TO PROJECT FAX NUMBER o Architect ❑ Tenant Agent ❑ Other ( ) - PROJECT NAME-`�•„^�,Q PRIMARY PHONE E-MAIL ADDRESS CONTACT :��Y�`� v pcf, (Z7,) b 4 Zj - i Zik5- .....- / i:so',d LENDER NAME Per RCW 19.27.095: Lender information is required if project value exceeds$5,000 MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) - U DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE ��� EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ -1��[1 00 C' SPRINKLEED BUILDING? ` RE YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO WATER SERVICE PROVIDER ;1 LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER :F7..LAKEHAVEN ❑ HIGHLINE o PRIVATE(SEPTIC) U PROJECT FLOOR AREAS AREA DESCRI' ON EXISTING PROPOSED TOTAL sg.FT. SQ.FT. SQ.FT. BASEMENT FIRST SECOND THIRD ADDITIONAL FLOORS(DESCRIBE) '''\\\ 1 11)\." DECK(0 COVERED OR 0 UNCOVERED?) GARAGE 0 CARPORT ❑ NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF **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$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION) AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES BBQS FANS GAS WATER HEATERS MISC(Describe) BOILERS FIREPLACE I SERI'S HOODS(commercial) COMPRESSORS FURNACES RANGES DUCTS GAS L G REFRIG.SYSTEMS PLUMBING )1. - BATHTUBS(or Tub/Shower Combo) LAVS Bathroo Sinks) URINALS MISC(Describe) DISHWASHERS RAINWATER YST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS(-met) 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, includi its officers and employees, upon the accuracy of the information supplied to the city as a part of this application. ,q NAME/TITLE // / DATE L/z l5O'l / ( . ature) (Title) !ll RELATIONSHIP T•/<R I CT 0 Owner 0 Agent Contractor 0 Architect 0 Other FOR OFFICE USE ONLY ❑NEW ❑ADDITION o ALTERATION ❑REPAIR o TENANT IMPROVEMENT BUILDING SHELL ONLY? o YES a NO BASIC PLAN? ❑YES o NO ZONING DESIGNATION CHANGE OF USE? o YES ❑NO NEW ADDRESS REQUIRED? ❑YES ❑NO UP/SEPA/SU? o YES a NO PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? o YES ❑NO Bulletin#100—April 2,2007 Page 2 of 4 k\Handouts\Permit Application