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08-103720 OF+IN . P�,_ FeCITYderal C E I V .. - .i.1_ l-7O a COMMUNITY DEVELOPMENT SERVICES PERMIT SF MF ME EL PL DE EN FP 333258n, 8 AVENUE Y,WA 53PO 2609 718 '4 s 808 APPLICATION �. TD www.dtuofedemlwau.canlT DERAL WAY ��/ The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type. • PROPERTY INFORMATION SITE ADDRESS Zc-© lc c),z c 1 (... f'I a)y Ft/rim,1 (CJS, SUITE/UNIT# ASSESSOR'S TAX/PARCEL# Z ®' 1 C) ,.N/- 1 1 LOT SIZE(sf) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) \)D)1-. V1.-. (c,., (Attach separate page for lengthy legal description) • PROJECT INFORMATION TYPE OF PERMIT BUILDING PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit orate ^ q ,.DEMI DEMI I,-. D� c �C t•.-• to C o� txp917, 61.01.4t... 9. ex-V41.•cc-c),---N ring /-�N‘ ,A' % LB�cMQ p,-. J CT A-LT'5 -?z, nor,cF7 "iC(5;�,' i �o,0 s, sei� -/A6 G vv .T/ a Litce-eil�..,-4 C,�#tO - , d cj,'- - PROJECT NAME(Name of Business or Owner Last Name) kJ\c LC lit.t ., '-`�- (� • PEOPLE INFORMATION PROPERTY NA l( PRIMARY PHONE OWNER t 1-A''•1-A''• (� t/t'1 ( +L 1Q,C SLect". (;v!?C: ) - MAIUN REBS CITY,STATE,ZIP E-MAIL ADDRESS CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE Q4'2CtJ tier... ( ) - MAILING ADDRESS CITY,STATE,ZIP CELL PHONE P 0 t6c,., -221,t, 5-,-,,,,..- —..4 (AS3 ) 6?i - aS'S:Y i CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE /� J7 FAX NUMBER �JJ,(/ CONTRACTOR'S REGISTRATION—NOLO L'e — CO qb . ` ( 253) call-- " L 2 EXPIRATION DATE E-MAIL ADDRESS e p-.40 No * 9 y 1 /....0 -7/22/2-0)0 APPLICANT CO�E APPLICANT NAME � !`OFFICE PHONE - MAILING ADDRESS CITY,STATE,ZIP CELL PHONE RELATIONSHIP TO PROJECT FAX NUMBER o Architect ❑ Tenant ❑Agent 0 Other ( ) - PROJECT NAMFF, PRIMARY PHONE j \ Tc, E-MAIL ADDRESS CONTACT %c a (.x33) 67.,:i - e-,41,--ss- -, ,5'S- i 1_.4_, -7 4 e o, r LENDER NAME PerRCW 19.27.095: vrv..c. Lender information is required if project value exceeds$5,000 MAILING ADDREO CITY,STATE,ZIP PHONE ( ) - • DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORKS ?, )CUA SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIREb? 0 YES 0 NO WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) i PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ. FT. SQ.FT. SQ.FT. BASEMENT FIRST SECOND THIRD ADDITIONAL FLOORS(DESCRIBE) DECK(❑COVERED OR 0 UNCOVERED?) GARAGE 0 CARPORT ❑ =STING PROPOSED TOTAL TOTAL EXISTING ST TOTAL PROPOSED Sr TOTAL sr NUMBER OF FLOORS **NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ III 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$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION) AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES BBQS 7><FANS GAS WATER HEATERS MISC(Describe) BOILERS FIREPLACE INSERTS HOODS(commerday COMPRESSORS „,,,"”' FURNACES RANGES DUCTSGAS LOG SETS REFRIG.SYSTEMS �L TUBS(or Tub/Shower Combo) LAYS(Bathroom Sinks) URINALS MISC(Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS crone) ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBBS SUMPS SIGNATURE AAAA.._.............. I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best of my 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 city, 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 ❑ADDITION ❑ALTERATION o REPAIR ❑TENANT IMPROVEMENT BUILDING SHELL ONLY? ❑YES a NO BASIC PLAN? a YES o NO ZONING DESIGNATION CHANGE OF USE? a YES ❑NO NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? ❑YES a NO PLATTED LOT? ❑YES a NO DEMO PERMIT REQUIRED? ❑YES ❑NO Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application