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06-105226 •' CITY OF t — ` Federal Way RECEI� c _ , Io PERMIT SF MF CO ME EL PL DE EN6. COMMUNITY DEVELOPMENT SERVICES 'I 33325 PH AVENUE SOUTH•PO BOX 9718 1 2 2APPLICATION FEDERAL WAY,WA 98063-9718 TO / / 253.835-2607•FAX 253-835-2609 ww.da,offedeuhI,alt.erm y Y OF FEDERAL WAY BUILDING DEPT, The following is require nformation–an incomplete application will not be accepted. Please print legibly(in ink)or type. ■ PROPERTY INFORMATION SITE ADDRESSa6-79622 C' I✓ NuySUITE/UNIT# 4' A y ASSESSOR'S TAX/PARCEL# I l 5 - 0 0 O LOT SIZE(sf) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy Legal description) ■ PROJECT INFORMATION ; TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING rkFIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this •ermit onl ) -� ra Iy�kt' })ot&c too , .e fi.I yle Stlyles-5-t'O PROJECT NAME(Name of Business or Owner Last Name) --rep.ov k t' tCNA"— & ‘i••1014- ' U PEOPLE INFORMATION PROPERTY NAMEPRIMARY PHONE n OWNER J14 ( ) _ MAILING ADDESS CITY,STATE,ZIP CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE HONE I ( — 'e J• ° -1--et, I a .) Dant ( )2 -o/ov MAILINGeTSF ADDRESS )D©X 53 1 µ l,l L STATE,�Il.�. W o��/f�J�O�/3 124)P, CELL N3E� 9 i FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DKfE FAX NUMBER III .20' -0 a-./ " / --3 -.B L. / / ( ) CONTRACTOR'S REGISTRATION NUMB (copy of card required with each application) EXPIRATION DATE _ti I D: F 1_,.1' i e_ ,._ APPLICANT COMP NY NAME_ APPLICANT NAME OFFICE PHONE M IAU h 5S �(� s rI u)i I t R06).2cp- o joV MAILING ADDRESS CITY, TE,ZI CELL PHONE _ 1� Cr. � .sSc 3/ 'Zt 4 , 1 A-. l ( NUM)3 53 -9P-3 RELAIONSHIP TO PROJECT - - ❑ Architect 0 Tenant ❑Agent ❑ Other(Describe) ( ) - CONTACT NAME PRIMA PHONE E-MAIL_ADDR e5 a)1 er i LENDER r t I NAME s MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) - II 'DETAILED BUILDING INFORMATION I ; EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED V $ VALUE OF PROPOSED WORK $ /8 '- SPRINKLERED BUILDING? YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES 0 NO WATER SERVICE PROVIDER O LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 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 0 =STING PROPOSED TOTAL . 7 �NUMBER OF FLOORS i.o3> .<,a,`A.,' ;s m ,,,rd.a: **NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ • . FIXTURES' ' : . Indicate number of each type offixture 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)Commereis) 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(toilet) MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS(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 of the city,including its officers and employees, • he accuracy of the information supplied to the city as a part of this application. NAME/TITLE DATE /0 I(c C •r :ture) (Title) RELATIONSHIP T. •ROJECT 0 Owner 0 Agent Iry tractor 0 Architect 0 Other e a vwr � I •s'6 .' x ac, a • x+ T '+k'•' r z rc ... " `� � -I�® 6 ,� •.Fx� ix�'.`"* Pf �.;`f �'� tnau�,u�^k� aw�.kz �a�o .,.s�,K �,.a.»,.0 „s.,.. � a,:,rx.,�. Tz^°.-Y3 '."'ice �"� '�� r� � ` ,��xa^�.te��P^ � �., €� ,s. ,i"� t� � �l��t���'�'Y°i ��,�;� �% 'E` ���b `�"�'� ��,, usx•a�.� ''az.� .�, wum�u�u, s �za,� � z l �,.r (�; �® ti �1t�„,_"z,v,``r ',,y -� 1� ¢ 1 ,tr,�rs oivillkil "ftp D i a • e ny .t ewe-. '- 6" x lam' el'2 1 r&3a:x✓. I°. ®ate 0.a ` '0 0. � W.v -,<e s ti:. %-! ° Rnlletin#100—.Tanuary 1.2006 Pace 2 of 4 k\Handouts\Permit Application