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07-105244 I* A�- . a OF A 0.7- 1 _05,R _ c( Federal Way RECEIVED PERMIT SF MF CO ME EL PL DE EN Og COMMUNITY DEVELOPMENT SERVICES 3332T7 p FEDERVENUE SWA 980 O BOX 971 r. 2 U P P LI CATI O N FEDERAL WAY,WA 98063-9718 '"' 253-835-2607•FAX 253-835-2609 u'',t'.cifi'll'dc,'ium''WV C)P FEDERAL,WAS' The following is requillnan Incomplete application will not ted. Please print legibly(in ink)or type. • PROPERTY INFORMATIION SITE ADDRESS_ X06 SO. ecuip.ts Dr,, (�kJ 44. ?PO 13 SUITE/UNIT# �/ _ ASSESSOR'S TAX/PARCEL# ( / 5 1 2- C) - '7 / 0 LOT SIZE(sf) O/4 LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) I/jI'/i/7��I'cluIrA (Attach separate page for'lengthy legal de doN • PROJECT INFORMATION TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION iELP/rt.lxlttu. 0 ENGINEERING 'FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide// detailed description of work included on this permit onlq) /,/ _ E•f/Ocil t141 /I4L T€rr P_Yr a 74 �\i•2 �_/bu S�.f 7 eYv[ 4� 4)14 co , & kid/14 / C-4 Urrt •1'74d- /Gr-fr us f,► ...(7~4 chitec-Ac,r /6 C![:c e.uft 7 r Y cy 7-2-" ka*„1 -See".rr j t• - PROJECT NAME(Name of Business or Owner Last Name) h!(l4 CO riarril • PEOPLE INFORMATION PROPERTY NAME PRIMARY PHONE u OWNER /LI GO / -l' (• 3) ye'Z /912- MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS yt S /j„Ila. 4v . aermilleak /OR c r)o7/ CONTRACTOR ! COMPANY f NAME APPLICANT N+WW�E g OFFICE PHONE 4Df 'i&' �w.uw4cetr tt. ha /VI°.��J (z/25 ) 77y - `ID`1`l MAILING ADDRESS / C TATE,ZIP CELL PHONE r:, ,,,,,, /y bio Ko '' • W 5'iiii irl / W 1436 (4'z5 ) .5d c? - 772-ZCITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER Cltri ' /9-19 /(951 to/-ov- BL /2/3//2vl)7 ('/25) 77y -63/7 Oe i CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS fR0rEc --/CPS L,j) ,...5/3/A 7 /ykloreco..4., APPLICANT COMP NAME APPLICANT NAME OFFICE PHONE 4(Ot 1- &Ia.*:/I S tC `$' M`lr ( *-5 ) 77q/ - q�71 MAGI LING ADDRESS� ,/ CITY,STATE,ZIP �j T CELL PHONEL �/ /971030 YO4 �• hJ NII '-4 414 I�v� FAXNU✓)ER v0 ??2:2- RELATIONSHIP ?22RELATIONSHIP TO PROJECT /-/ 0 Architect ❑Tenant ❑Agent er - /n 0'6"-4•1 ( y,�5) 27y - (--3/7 PROJECT NAME/ /,�/ // PRIMARY PHONE E-MAIL ADDRESS CONTACT 46 lam''a/C s ( gas) 56 a, - 722 Z �/C••pfoccp.,t6 `mi. LENDER NAME//v /4 Per RCW 19.27.095: Lender information is required if project value exceeds$5,000 MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) / • DETAILED BUILDING INFORMATION EXISTING USE 6/2)040 S-,4 rt._ PROPOSED USE /V4— EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ /CVO SPRINKLERED BUILDING? ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN o HIGHLINE o PRIVATE(SEPTIC) • r • • PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT ,�/ FIRST ZSD� 7A -'"IJ''t 2 j0 SECOND THIRD ADDITIONAL FLOORS(DESCRIBE) DECK(❑COVERED OR ❑UNCOVERED?) GARAGE ❑ CARPORT ❑ EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF NUMBER OF FLOORS / f Me�z- **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$ (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(commeretal) 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 CLOSI;Ib(Toilet) ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBBS SUMPS SIGNATURE 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. 7/2-0/) SIGNATURE: DATE Pr Owner and/or Authorized Agent FOR OFFICE UBE ONLY ❑NEW o ADDITION o ALTERATION ❑REPAIR c TENANT IMPROVEMENT BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES ❑NO ZONING DESIGNATION CHANGE OF USE? o YES o NO NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? o YES o NO PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? ❑YES o NO Bulletin#100—August 16,2007 Page 2 of 4 k\Handouts\Pernvt Application