The URL can be used to link to this page

05-102390 RE.CiVED 0 5-- I D z 3 W --f 411/ C031MLNrn DEiELOPMe.ATi6Ri7L7i5 33530 FIRST WAYSOUTH•PC BOX 9;18 aFEDERL598o63-9718 1111 PERMIT APPLICATIM U � Q� 2,3.66,1s'FAL25,_66,-q29 .. .eilvo(feder.abk i,SOm CITY Or FEDERAL WA For office Use only: FW File Number: - -BUILDING DEPT. The ollowin. is re.uired i ormation-an incom•lete a• •lication will not be acce.ted. Please •rint le.ibl (in ink)or s e. ■ PROPERTY INFORMATION SITE ADDRESS: «1 — > SUITE/APT# .44!:: ' ASSESSOR'S TAX/PARCEL#: 1 .6 Z 1 04 - C1O a I SQUARE FOOTAGE OF LOT: LEGAL DESCRIPTION(e.g.:Acme Estates,Lot i) (Attach separate page for lengthy legal description) ■ PROJECT INFORMATION TYPE OF PERMIT(This application): ❑BUILDING 0 PLUMBING ❑MECHANICAL 0 DEMOLITION 0 ELECTRICAL ❑ENGINEERING VFTRE PREVENTION SYSTEM PROJECT DESCRIPTION rouide detailed description of work included on this permit only): 1 .ar i.z IC' (Ept.Ebr iAit(e_EeSn (#J /JEW 6teii> G&-1cJ1._ PROJECT NAME(Name of Business/Owner Last Name): ` r 0 Ti 1,F' • PEOPLE INFORMATION PROPERTY NAIZe. PRIMARY PHONE: OWNER: t-v65 Pfr__.:EVE )1"-* ( ) - MAI © 1144JCT IATA CY TSA TE,ZIP CONTRACTOR: NA /lt1). �� COMPANY OFTICEPH NE: lAWImo® KESS(STREETA� ` KESS;): C STATE,Z)P CELL PHONE: t� �L.�' UV/LI_Ei(W ( )7 >-q CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: EXPIRATION(DATE: FAV NUMBW: 1R -81 - 0o 0001' 00 (2 / . I / off (475).0,3- CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DA (copy of card required with each application) 1 o f LENDER: NAME: k..) - (If Proposed Value>$5,000) DAYTIME PHONE: ( ) MAILING ADDRESS REET ADDRESS;): CITY,STATE,ZIP APPLICANT: NAME: r. COMPANY OFFICE PHONE: MAILIN a Li S( ET ADDRES ): CITY,STATE,ZIP EVENING PHONE: ( ) RELATIONSHIP TO PROJECT: FAX NUMBER: 0 Architect ❑Tenant 0 Other(Describe): ( ) - CONTACT PERSON FOR THIS PROJECT: ❑Property Owner [WC;ontractor ❑Applicant E-MAIL ADDRESS: • DETAILED BUILDING INFORMATION EXISTING USE: PROPOSED USE: EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $ ,� SPRINKLERED BUILDING? ❑YES ❑NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: ' S 0 NO WATER SERVICE PROVIDER: 0 LAKEHAVEN ❑HIGHLINE__--- 0 TACOMA ❑PRIVATE(WELL) SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGNE 0 PRIVATE(SEPTIC) ■ PROJECT FLOOR AREAS ' AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL BASEMENT FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE/CARPORT HOW MANY FLOORS? TOTAL DUSTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED **NEW HOMES ONLY** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ • FIXTURES 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 $ 63 AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOODS(Commercial) WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS(orTub/Shov.cr Combo) SHOWERS WATER CLOSETS(Toilet) 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 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,andfled 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' , •rmation supplied to the city as a art of this application. ,.— f NAME/TITLE: r'• 1 . 1--6(1J. DATE: S-("I`d (Signatur I (Title) RELATIONSHIP TO PRO ECT: 0 Property Owner 0 Applicant aveontractor 0 Architect 0 FOR OFFICE USE ONLY: o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO ZONING DESIGNATION: CHANGE OF USE? ❑YES a NO NEW ADDRESS REQUIRED? ❑YES ❑NO UP/SEPA/SU? o YES a NO PLATTED LOT? ❑YES a NO DEMO PERMIT REQUIRED? o YES ❑NO Bulletin#100-January 13,2004 Page 2 of 4 k:\Handouts-Revised\Permit Application