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06-105492 ,SUE1)TTED 411 aOF A - - FederalWay OCT 2 6 200 nom, 0 b R M I T S F MF CO ME EL PL DE EN.1 �- =f _ _ Z COMMUNITY DEVELOPMENT SERVICES y 3332FEDERAL UE so uni 8063-BO 8 2539714TY OF FE!" •V a ' fCATION rD FAX 253-835-2609BUILD! / 0www cityofjederalway.com The ollowin. is re.wired in ormation-an incom•tete a•.lication will not be acce.ted. Please •rint le.ibl in in or •e. ■ PROPERTY INFORMATION . SITE ADDRESS "-II"ti(.aJ14°."."16'P.7fil .moi`= &C.c"Fie- SUITE/UNIT# 10\--- ,CI ASSESSOR'S TAX/PARCEL# I J S Z 9 - C., © C LOT SIZE(sj9 LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal desaiptton) r ■ PROJECT INFORMATION TYPE OF PERMIT 0 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 only) r7 'NL=`'05 € z lL NC S' t, .,rt-\,•--4 14- C .L.)U--A PROJECT NAME(Name of Business or Owner Last Name) IC4":—`'{.lkKZ A---- P-,61"14.- tS 0 14 _ - } PEOPLE INFORMATION PROPERTY NAME y ` OWNER I VOS (F,+v_�, ] , L PRIMARY PHONE - 0 MAILING ADDRESS ` CITY,STATE,ZIP I _ CONTRACTOR CO)IPANY NAME APPLICANT NAME (� OFFICE PHONE T -rt_-k> rv ( `1-tuTot, ��(�.'1-p1i- Qui( (Z-5-'s ) c` - zv MAILING ADDRESS CITY,STATE;ZIP CELL PHONE CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER T' - 1-A t-- ci 5-B L /. / C (-Z ) l GL.. (PIS CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each applications EXPIRATION DATE v_ �_ L lcp9 ` c ., - k-, / 3 / t) APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE MAILING ADDRESS CITY,STATE,ZIP CA-ex,— - CELL PHONE LIQ Zoo 1D"1 `7e vsI-- 51CIAT7 ( ) RELATIONSHIP TO PROJECT FAX NUMBER 0 Architect 0 Tenant yl-Agent 0 Other(Describe) )t Z -Q 1 CONTACT NAME. (Z'� � � J` L `}1 its PRIMARY PHONE I E-MAIL ADDRESS �-- 1 (t5 ) - 2'V I LENDERY 0.-- 1 r. e)-v;-1 va r-,°.>? f ,p IT,.i'.1v;ii; 4: NAME '4.s,•'..' I• I.<IX,i, a '-,:X•CX.t::. q'.. MAILINO ADDRESS CITY,STATE,ZIP 7 • • • ■ DETAILED BUILDING INFORMATION - EXISTING USE �,C1-4 -t PROPOSED USE Q1�--DT (LA�� EXISTING ASSESSED/APPRAISED VALUE $ '�' VALUE OF PROPOSED WORK ` 1 400 SPRINKLERED BUILDING? &YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES ❑ NO WATER SERVICE PROVIDER a LAKEHAVEN a IIIGHLINE 0 TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER a LAKEHAVEN 0 HIGHLINE . 0 PRIVATE(SEPTIC) • • PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ. FT. SQ.FT. BASEMENT FIRST 47.40t 1'4 .z, it • SECOND THIRD FOURTH • ADDITIONAL FLOORS(DESCRIBE) • DECK(COVERED?) GARAGE 0 CARPORT 0 NUMBER OF FLOORS EXISTING PROPOSED TOTAL ¢ T 1 TDP, r `STAT.PROPoeEDsr"f.:2- r I ' ,' 0 AL 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(commemiat) WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS(or Tub/sbowerCombo) SHOWERS WATER CLOSETS(roam) MISC(Describe) DISHWASHERSSINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS watt.)LAVS(Bathroom nks) 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 1 am authorized by the owner of the above premises to perform the work for which the permit application is made. It 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,including its officers and employees,upon the accuracy of the information supplied to the city as a part of this application. NAME/TITLE S t 4 c Y-e c CCS M f��L%'ttL DATE t5:)---Z-LA— (Signature) (Title) RELATIONSHIP TO PROJECT ❑ Owner ❑Agent tpk2ntractor 0 Architect 0 Other fA'd ,1e)tZt tl(e)i bf''t �S'CE1 Ea 's:� ie�te ��i.€, telt r7 y.: •;;(� I3xtcb .4?• ,(ot r f!--A.a'/ ViX•4 .1 ,ldo t a,I e 3 ;to', '� e� 1;1E411 tifi' 1:4 01) Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application