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07-106396 �`NO. ,r CITY OF �sotio , 01 - 1 Ok 5g (,-.2 Federal Way ti $ PERMIT COMMUNITY DEVELOPMENT SERVIC O' \ l r SF MF CO ME EL PL DE E FP 33325 STN AVENUE SOUTH•PO BOX 9718 cQ APA P P L I C AT I O N T D FEDERAL WAY,WA 98063-9718 f 253-835-2607•FAX 253-835-2609 8 (F`�N / / C 1 uuw.ciuc4lolkderalwatl.con t y1A The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type. • PROPERTY INFORMATION SITE ADDRESS l i Gj ', '.. ?(')-c." ST 2 F el' SUITE/UNIT# ASSESSOR'S TAX/PARCEL# 6 9 2 I 6 4 - cl Z Q a LOT SIZE(s/) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal description) • PROJECT INFORMATION TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING AFIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit onht) ADD Arlo 1{Et,oc-a-[ 137 si'g iAKLe?, v1EAD5 Fat tile.rs1 Te.fy A uT tri Ex1-51- ►iJ (,► SO tLD Lk) t . ' lcl5''l><)Gt Still-D IBJ& v.5 fUt.t_LI 512�t►sLE►2.ED. PROJECT NAME(Name of Business or Owner Last Name) T IZA D E -YO E t • PEOPLE INFORMATION PROPERTY NAME PRIMARY PHONE OWNER (4A, 1.1 1►44E�!-rMew ?12i' EiaTi — (GiC5-5 456- 07 113 MAILING ADDRESS CITY.STATE,ZIP E-MAIL ADDRESS 15 6W !,T H 5 TeEE T ►?off-[t_A til Dl ORE-4.6 t.lt CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE roto FIRE DTeeTtal.l ,'PoJ4 cLA1 t! (426 )4?,$ -417 MAILING ADDRESS Ise5�, CITY.STATE.ZIP W01,01I4V 1 L5 CELL PHONE 146.012 Mg I LLe-QE QNto&3D B RD S.attO vLA SN . 9$0'12. ( ) - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER / 26-01- lot 681 - DO- 1: t_ 12-31 - ©� 2� $a3 42 0 CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS CO 66-0 F (Io til IAt - 43-©9 dclarK@Co6cdcire.corr. APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE 4 AWE. AS co,uTeAe-rt . ( ) - MAILING ADDRESS CITY,STATE.ZIP CELL PHONE ( ) RELATIONSHIP TO PROJECT FAX NUMBER ❑ Architect ❑ Tenant ❑Agent Other Cb LA.1'le-Ac re,F.-. ( ) - PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS CONTACT l7O061 CLARL (4z5 )b86 -6.311 cicl2rk@co5ce5(nre.ctn LENDER NAME Per RCW 19.27.095: Lender information is required if project value exceeds$5,000 MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) U DETAILED BUILDING INFORMATION EXISTING USE r.K E 1 /�" I L ' a D? PROPOSED USE 1 ,E.-,T A,t L S).%-Qty EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 2(e) 44 9 en SPRINKLERED BUILDING? XYES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? $.YES ❑ NO WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ TACOMA U PRIVATE(WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) • III 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 ❑ 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 INSERTS HOODS(Commercial) COMPRESSORS FURNACES RANGES DUCTS GAS LOG SETS REFRIG.SYSTEMS PLUMBING BATHTUBS(or Tub/Shower combo) LAYS(Bathroom Sinks ) URINALS MISC(Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toilet( ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBBS SUMPS SIGNATURE I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that the issuance of this permit does not remove the owner's responsibility for compliance with local,state,or federal laws regulating construction or environmental laws. 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, but only where such claim arises out o 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 ap ation. SIGNATURE: / / �J� C� , DATE Z tQ Property Owner and/or Authorized Agent FOR OFFICE USE ONLY NEW ADDITION ALTERATION REPAIR -]TENANT IMPROVEMENT BUILDING SHELL ONLY? YES NO BASIC PLAN? YES NO ZONING DESIGNATION CHANGE OF USE? YES NO NEW ADDRESS REQUIRED? YES NO UP/SEPA/SU? YES NO PLATTED LOT? YES NO DEMO PERMIT REQUIRED? YES NO Bulletin#100—August 16,2007 Page 2 of 4 k\Handouts\Permit Application