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05-101366 ` CITY OF RECEL a - 1 a 34 « -FederalWay PERMIT MAR 2 5 ZOOF MF CO ME EL PL DE E FP COMMUNITY DEVELOPMENT SERVICES •33325 8TH AVENUE SOUTH•PO BOX 97]8 APPLICATION ' • /FEDERAL WAY,WUA 98063-9718971 TD 253-835-2607.FAX 253-835-2609 F�pE�'�' �i ,'ww cityoffedera1way.cam BUILDING j? The ollowin, is re.uired in ormation-an incomplete a.plication will not be accepted. Please .rint legibl in ink or .e. N• PROPERTY ' `INFORMATION0 a L( SITE ADDRESS 3 9 D 3IAD k fl-- RA,• S IA) SLty t SUITE/UNIT# ASSESSOR'S TAX/PARCEL# 1S D q © 0 - © 3 e 0 LOT SIZE(V) LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) (31,, f)-1 I/wl�-�- 0 S' l/ C -.0 U p c (P -0 0 - CO h separate page for lengthy legal description) ■ PROJECT INFORMATION TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL 0 DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING% FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu) Qt\6Ct1 Vtr-SSrbr r -ei (-tiVv\q a PROJECT NAME(Name of Business or Owner Last Name) (h-e,jL �!I!' T-'Mi • PEOPLE INFORMATION PROPERTY NAMEtt PRIMARY PHONE i OWNER Ai Abe l) �C - M LING ESS CITY,STATE,ZIP CONTRACTOR OMPANY NAME APPLICANT NAME OFFICE PHONE r�r r� Piro �b�Tiv. _ �c�un 1�ALL (a�3) �t,�(e 2D v is MAIL G AD RESS l CITY,STATE,ZIP CELL PHONE l a-)0r) r)6 �- -7' wA 'ipay ( ) - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER C, 0._ � EXP TION DATE FAX NUMBER 11 -1 L-A Q L i 3 a 3) - ( ) - (C�ONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE L $ 'LeZE e0 i 1L 1 /v /S /66, APPLICANT C MPANY NAME � D APPLICANT NAM OFFICE PHONE LZ n B T Fil ir4-- ` rD"-'1'0 v\ T"\C; -E-6k Li C C e.- (o2,S ) aU) - .26)-/0 MAILING ADDRESS CITY,STATE,ZIP CELL PHONE 0')O7 r) ji- (-`- 7;:L 6.)15, q Pl at( ( ) - RELATIONSHIP TO PROJECT FAX NUMBER 0 Architect 0 Tenant 0 Agent 'Other(Describe) C014,-,tho' 014,-, ro,-- 0-63 ) /,9 9, -6 1 J-b CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS �k� i�‘.L< (a,3) ceaip- -- > a iC LENDER Per RCW 19.27.095: Lender information is NAME required if project value exceeds$5,000 MAILING ADDRESS CITY,STATE,ZIP • DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE 0 ,._ EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ c. t'�' SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE n PRIVATE(SEPTIC) ! +� PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL • SQ. FT. SQ. FT. SQ.FT. BASEMENT FIRST .3& /34,6 / 34,6 SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE ❑ CARPORT El EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF NUMBER OF FLOORS **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(commeromaq WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS • PLUMBING BATHTUBS(orTub/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 Sulks) 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,upon the accuracy of the information supplied to the city as a part of this application. NAME/TITLE ignature) GZ S?,t DATEc_310/1— ?�IaS(() ignature) (title) RELATIONSHIP TO PROJECT 0 Owner 0 Agent Contractor 0 Architect 0 Other FOR OFFICE USE ONLY ❑NEW ❑ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? o YES o NO ZONING DESIGNATION CHANGE OF USE? ❑YES o NO NEW ADDRESS REQUIRED? n YES ❑NO UP/SEPA/SU? ❑YES o NO PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? ❑YES o NO • Bulletin#100—August 19,2004 Page 2 of 4 k\Handouts\Permit Application