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04-103118 COMMUNITY DEVELOPMENT SERVICES 33530 FIRST WAY SOUTH•PO BOX 9718 CITY OF illiii!....4..J • FEDERAL WAY,WA 98063-9718 Federal Wad w E� 2536141/5•FAX:253fi61 4129 ,,nko „�,,,,r. _�G, ,Ph.�E IT APPLICATION S ��emcil4o((edemllwny.enmaft For OBro Use Only: FVC File Number: C� 1.1 a 2 1 i__ 0 o / The ollowin. is re•uired in ormation-art incom.fete a..iication will not be acce•ted. Please .rint le.ibl (in ink)or •e. . ,J \ p ■ )PROPERTY INFORMATION tit ADDRESS: ,27 100 1 LSV t d Ao Y W, LSV i+ ^ SUITE/APT#614 tit I I 0 ASSESSOR'S TAX/PARCEL#:Z S e2 LI co`J- - 0 \_© SQUARE FOOTAGE OF LOT: LEGAL DESCRIPTION(e.g.:Acme Estates,Lot 1) (Attach separate page for lengthy legal description) . a PROJECT INFORMATION TYPE OF PERMIT(This application): 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING reFIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit°n111): E +e ri U l Fitt S p 12.4 n pr.IL .p ote(tifin fiY\r 8 W 'II AV-M. . Moltn- iN � - PtIk-1e - p t c- c r i A , c. 4(,e ClA f-1A{- e. . ._ I G cam- Ai(en PROJECT NAME(Name of Business/Owner Last Name): C ni ,4 v lOk is PEOPLE INFORMATION • PROPERTY NAME: /� PRIMARY PHONE: OWNER: R4 -C" _ (�tl`3.�\ L 1.`,. ( ) - MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP CONTRACTOR: NAME COMPANY OFFICE PHONE: POI-WI( fipe P 'W: a (7-93 ) 'Tit, - J7qt, MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP CELL PHONE: 27C2 '701`h Wim X01cf -1`ct(a'Y'1C1 / W ti .4V/ ( ) - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: EXPIRATION DATE: FAX NUMBER: 411( L1-_L-J (Z L i I- 1 / v / 6) (70 ) °IIT - 6jcb CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE: (copy of card required with each application) ATPld ril ` F LENDER NAME: DAYTIME PHONE: (If Proposed Value>$5,000) ( ) - MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP APPLICANT: NAME: . COMPANY , OFFICE PHONE: c t w t CcW— PPtP-i o " FI PI PRI-al-go (263 ) 12E - -1,-/A0 . MAILING ADDRESS(STREET ADDRESS): CITY,STATE,ZIP , EVENING PHONE: 21C1 10+11 tkvo ti e eti ci- Tot c�ryytA / Wow-124 ( ) - - RELATIONSHIP TO PROJECT: FAX NUMBER: 0 Architect ❑Tenant Other(Describe): ' 1 PonAtt'►-- be.A tA-cro-t Ls I ) Gil 71) _ tjl s b CONTACT PERSON FOR THIS PROJECT: 0 Property Owner ❑ Contractor O'Applicant E-MAIL ADDRESS: ■ DETAILED BUILDING INFORMATION EXISTING USE: PROPOSED USE: EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $ ''1 Sfri SPRINKLERED BUILDING? VYES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?YYES 0 NO WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) ■ PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL BASEMENT FIRST r ^SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE/CARPORT HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED **NEW HOMES ONLY** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ IIIIIIMIIIIIIIIIIIIIIIIIIIIIIIIDIEEMIMIIIIIIINIIMMIIIEIMIII- Indicate number of each type of fixture that is 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(commadaI( WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS(or Tub/sho.RrCombo) SHOWERS WATER CLOSETS(-rode) MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYS WASHING MACHINES URINALS HOSE BIBBS LAYS(Bathroom Sink 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 j 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, i including its officers and employees,upon the accuracy of the information supplied to the city as a part of this application. 6 1 'Se 'C E,`�-'DATE: B -S-01 NAME/TITLE: (Signature( (Title) RELATIONSHIP TO PROJECT: ❑ Property Owner o Applicant Contractor o Architect ❑ FOR OFFICE USE ONLYs: a NEW a ADDITION o ALTERATION ❑REPAIR a TENANT IMPROVEMENT BASIC PLAN? ❑YES a NO BUILDING SHELL ONLY? .' o YES.-p NO ZONING DESIGNATION: CHANGE OF USE? ❑YES a,NO NEW ADDRESS.REQUIRED? a YES o NO UP/SEPA/SU? ❑YES ❑NO PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? a YES ❑NO ) Page 2