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09-101063
CITY OF !2 ? / Of0 ... Federal Way C I\ — COMMUNITY DEVELOPMENT SERVICES PERMIT SF MF CO ME EL PL DE EN FPD 33325 8TN AVENUE SOUTH•PO BOX 97118/1 p 2 p 'APPLICATION FEDERAL WAY,WA 98063-9718„ 8063-9718 19Il TD / / 253-835-2607•FAX 253-835.2609 WWW.(Duo jfede corn The ollowCtg1 OF FEDERAL WAY f required f?� canon-an incomplete application will not be accepted. Please print legibly(in ink)or type. /• PROPERTY INFORMATION 3SITE ADDRESS .)U 3 3 f/9-C! ;-�'( j,41,1,475-2- c. SUITE/UNIT# ASSESSOR'S TAX/PARCEL# Z- t/ 0 - 4/ e LOT SIZE(s) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach sepurtae page for Lengthy legal description) IN PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu) `'f rj^ PROJECT NAME(Name of Business or Owner Last Name) ct 6 rcA4+''t A— - %U II PEOPLE INFORMATION PROPERTY NAME ' I PRIMARY PHONE Y I OWNER 44, ti -�'1.✓\ erO L ( ) - MAILING ADDRESS 4_ CIT STAT ZIP E-MAIL ADDRESS • _ Apt,/ . CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE ‘Al (JZ17-1(42--.4- 5414e>"1 MAULUNG ADDRESS CITY,STATE,ZIP,e CELL PHONE d OF FEDERAL WAY 6 BUSINESS LICENSE NUMBER c EXPIRATION 6/ FAX(2_53 NUMBER 'T Li 71, CrCITY CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS t`a6 TC IF S 1 5-6 1-- L /G��.5' 2rr6vvc 11:0' (2c-1,? (K k, APPLICANT COMPANY NAME —�_ APPLICANT NAME OFFICE PHONE MAILING7 ,- ( ) _ ADDRESS CITY,STATE,ZIP CELL PHONE RELATIONSHIP TO PROJECT FAX NUMB ER 0 Architect ❑ Tenant ❑Agent 0 Other ( ) - PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS ( CONTACT 44-rZ tI'^t' (Z7i Z i-5---- 4 7L' LENDER NAME Per RCW 19.27.095: Lender information is required if project value exceeds$5,000 MAILING ADDRESS CITY,STATE,ZIP PHONE ( ■ DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE �./.►- EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ Z-‘, e,©0 0 a � SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) • • PROJECT FLOOR AREA$. AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST SECOND THIRD ADDITIONAL FLOORS(DESCRIBE) DECK(0 COVERED OR 0 UNCOVERED?) GARAGE 0 CARPORT 0 NUMBER OF FLOORS emsrtio PROPOSED TOTAL TOTAL aa Erom Sr TOTAL PROPOSED SF TOTAL Sr **NEW HOMES ONLY'* NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ FLXTURES 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(commmrio COMPRESSORS FURNACES RANGES DUCTS GAS LOG SETS REFRIG.SYSTEMS PLUMBING BATHTUBS(or Tub/shower Combo) LAVS(Bathroom sinks) URINALS MISC(Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS froileq ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBBS SUMPS SIGNATURE I certifyweder penalty ofthat I ant the roe owner or authorized agent oftheproperty ro P ty perjuryproperty rtTJ 9 P P rt*Jcertifyof my e owner.I that to the best 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 of the reliance of the c4ty,including its officers and employees, upon the accuracy of the information supplied to the city as a part of this application. — SIGNATURE: =? DATE Property Owner and/or Authorized Agent ❑NEW a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT BUILDING SHELL ONLY? ❑YES a NO BASIC PLAN? ❑YES a NO ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO PLATTED LOT? ❑YES ❑ NO DEMO PERMIT REQUIRED? ❑YES a NO Bulletin#100—January 1,2009 Page 2 of 4 k\Handouts\Permit Application