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05-102502 4 `. AMMUNtrY pm, '' - FederalwayAA /y PERMIT .04)Pmersi - L 0 �" COMMUNITY DEVELOPMENTSERVICESY y z0PSF MF CO ME EL PL DE EN(a) 33325 8rrr AVENUE SOUTH•PO BOX 9718 AP P L I C AT I O N FEDERAL WAY,WA 98063-9718 253-835-2607•FAX 253-835-2609 www.cituof feder¢Itoau.com The followiis'• Ped information-an incomplete application will not be accepted. Please print legibly(in ink)or type. 1 ® PROPERTY INFORMATION SITE ADDRESS �(/t7 jt�/,,�1/< u/ / / /e r SUITE/UNIT# HW ASSESSOR'S TAX/PARCEL# - LOT SIZE(sj) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)L��/(CI'co 7; /lc 7..-.7. 'rL /Q a.� X5 (Attach sep Wale page for lengthy legal descaption) • PROJECT INFORMATION TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL / ,'re A/ark ❑ DEMOLITION ❑ ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM PR JECT DESCRIPTION (Provide detailed description of work included on this .ermit oni d de, SM6 ( e r Aeec r�s��++L `16✓' /SA V 3"710), 011/s i�c c fz' 7 - , are. l'e Liii �/ ,rc+ Y. o'4 1/C 1 � t.,..),b %.. /J ' Lire ,, 1-0,7/. f'ec-�`c,a 4-/car 4 ��rtris) c� /y< PROJECT NAME(Name of Business or Owner Last Name) ('QF; //-Ye /. • PEOPLE INFORMATION PROPERTY NAME ` /� PRIMARY PHONE p OWNER NAME,,,, / I�C�L/e4:07e i7 f (✓l)G )Ss.. - yafo MDin dix 9 /4/ 19'i , 6i4 9dYd7 CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE MAILING ADDRESS / CJITY,S ATE,ZIP CELL PHONE :95 Q3 J5)&` /file /V . //e,"7 yl,�� /(,t)>•4 *Os-a ( ) CITY OF FEDERAL�EWAY BUSINESS/fife NUMBER EXPIRATION DATE FAX NUMBER 6-V 3-L .6 i", Y`fid B L / / (4's,�b5ct - yi.3Y CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE rt N 4 _ - 4 / z c,2 .e/ 6 ' ? '0y APPLICANT COMPANY Y NAME /'w AP. IC/A�NT NAME, OFFICE PHONNNE lc ec, et? "Arm 47 Cl//fes/7 (P 9r)LL 9? -�//6, MAILING,99(J054,/ ./4v 4) //pliGic , Ls)ANtij� ( ) RELATIONSHIP TO PROJECT / FAX NUMBER 0 Architect 0 Tenant 0 Agent/Other(Describe)(On k r/Or (yp)J) 6%7 -a9/5,5 CONTACT NAME PRIMARY PHONE E ADDRESS en (, w (1%�s") G,ci''2 - 0.2/74 , t'nG ✓`i✓e.Sysied7. es/ : Co") LENDER Per R�,00©95, Lender tnfarrnation is NAME requtredif`,roject value exceeds$5,000 MAILING ADDRESS ' CITY,STATE,ZIP • DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $7jGj a„ CO SPRINKLERED BUILDING? a YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES a NO WATER SERVICE PROVIDER ❑ LAKEHAVEN a HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) • • PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE ❑ CARPORT❑ NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTALESIST'ING Sr zarsia inFossb SB TOTAL SR **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 $ 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(or Tub/Shower Combo) SHOWERS WATER CLOSETS(Tolley MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAYS(Bathroom Sinks) 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,and filed against the City of Federal Way,but only where such claim arises out of the reliance o the city, including its officers and employees, upon the accuracy of the information supplied to the city as a part of this application. - �f/ DATE S�t�7/s'_� NAME/TITLE //� �� i_-lure) / (Title) RELATIONSHIP TO P• a JECT ❑ Owner ❑Agent ❑ Contractor 0 Architect 0 Other FOR OFFICE USE ONL u NEW u ADDITION a ALTERATION L REPAIR J TENANT IMPROVEMENT BUILDING SHELL ONLY? ❑YES c NO BASIC PLAN? a YES'+±' a NO ZONING DESIGNATION CHANGE OF USE? DYESa NO NEW ADDRESS REQUIRED? YES L NO UP/SEPA/SU? a YES' a NO PLATTED LOT? r YES a NO DEMO PERMIT REQUIRED? a YES' a NO Bulletin#100-January 7,2005 Page 2 of 4 k\Handouts\Permit Application