Loading...
07-100517 -VT7 OF.8'r''" ^+q..' l C V - ¶ 1 7 'Federal way cov P F.,RM IT •_, — — coMnrumrrDEVELOPMENT SERVICES ,r MF CO ME EL PL DE ENE 33325 87"AVENUE SOUTH•PO BOX 9718 FEDERAL WAY,WA 98063-9718 JAN 3 o 7 P P L I C AT I O N TO .253-835-2607•FAX 253-835-2609 --- unuut.cihtn(fcdernhvnu.cum , / • . .L wig 13 The following is re`r OF r .1'3,.p•f.an incomplete application will not be accepted. Please print legibly(in ink) or type. .- . , .' U lvv ■ PROPERTY INFORMATION , • . SITE ADDRESS ''... --1.- --1_...5ile . © '/ SUITE/UNIT# 01 ASSESSOR'S TAX/PARCEL# 61 0 L - O 4_ 0 LOT SIZE (sf) • LEGAL DESCRIPTION (e.g.Acme Estates, Lot 1) (Attach separate page for tengthy legal deacnption) ■ PROJECT INFORMATION TYPE OF PERMIT ❑ BUILDING 0 PLUMBING ❑ MECHANICAL 0 DEMOLITION ❑ ELECTRICAL 0 ENGINEERING FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlg) PROJECT NAME(Name of Business or Owner Last Name) Sus/'i 'e f t) Trill h/"" /y'•Af i Ite • IIIPEOPLE INFORMATION J PROPEROWNER TY e•.ME \ PRIMARY PHONE .e. I A. MA L i DDR C __i _ a e) _ ( ' ITYSTATE,ZIP , E-M IL •DDRES • ...: .w ■ . kimimmiCieA /. d, i = CONTRACTOR `r\ MP.ANNY NAME _we_ APP NTNAME (OFFICE PHONE /� MAILING ADDRESS `1 �.r V 1 `i l CI SAE,ZIP �� w `�/ f JLL. �. _ CELL PHONE t"". ►t L. . • i . ill, AJG .(__ ) w O F DE• L WA :MESS LICE`S NUMBER p 3 TION DAT FAX NUMBER 1 if _' i\^ - OA. COPY of card required CONTRACTOR •• GIS 7-1•N NUMBER EXPIRATION DATE E-MAIL ADDRESS with each application \DA-- -vA i' e51.0 af- 1 I Q APPLICANT OMPANY NAME AP L CANT NAME 1. A,Dc -1 f� I��,-�_?( 7� y � 4 ` OFFICE PHONE/�/S ( SS V j�f�' l�' ..�. TE CELL PHONE RELA SYSIIPTJROJEC't FNc-- 16k cb ' `'` i UJ/ - .l FAX NUMBER ❑ Architect ❑ Tenant ❑Agent ❑ Other PROJECT NAM PRIMARY PHONE CONTACT A/\ V �-• C ( E-MAIL ADDRESS LENDER NAME Per RCW 19,27.095: Lender information is required if project value exceeds$5,000 MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) -: R.-DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE • •EXISTING ASSESSED/APPRAISED VALUE $_, VALUE OF PROPOSED WORK $ i � 4 > ' PRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 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) -,l 4r.'ra;;'Y 7tr k� F ,.yy�n .;�i .z F ._ •\'J :i•' •}x""s'+ i... ?t - Wit f- �) ta' t •?,. ��Ygs:t .•{.' .� ..+.. i ( t�. • ,,,,, , ,,,,,, ,,,,,,,, ,,,,�, ,,.., ._ e, u. ,� ,.,.,,,.,.:..... ....•• . - awe .... �..'x-. - ,..,.,..� ......,...... .......•..,..........,.,.,,.. AREA DESCRI N EXISTING PROPOSED TOTAL SQ. FT. SQ. FT. SQ.FT. BASEMENT IRST �/ 22 I 1i 2 Z-) GOND THIRD ADDITIONAL FLOORS(DESCRIBE) DECK(0 COVERED OR 0 UNCOVERED?) GARAGE 0 CARPORT 0 £XOSTJNO I PROPOSED I TOTAL TOTAL EXISTING SF TOTAL PROPOSED ST TOTAL Sr NUMBER OF FLOORS 111 "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 $ (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(Commercial) COMPRESSORS FURNACES RANGES DUCTSs. .., GAS LOG SETS REFRIG.SYSTEMS PLUMBING , BATHTUBS for Tub/Shower Combo) LAVS(Bathroom Sulks) URINALS MISC(Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS trotetl ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBBS SUMPS SIGNATURE • 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. q. NAME/TITLE (7_�ivr^^'‘- (iL/ Pcej4 /'is�a�DATE ( — Z- /— 0 (Signature) (Title) RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ,p- ontractor 0 Architect ❑ Other o NEW o ADDITION ❑ALTERATION o REPAIR o TENANT IMPROVEMENT. • BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO ZONING DESIGNATION CHANGE OF USE? o YES o NO NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO i • Bulletin#100—January 1,2007 Page 2 of k\Handouts\Permit Application .