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07-102040 FederaiWay APR 1 7 2°° :ERMIT COMIRMITY DEVELOPMENT 17 SF MF CO ME EL( DE EN FP PE!ffiRAL WAY. 11818 euLo I C1TION :ro / 253607•FAS2534DE r. www.cittioffederalwaq.com The PROPERTY INFORMATION SITE.ADDRESS 3Z I ZS \VEyE re-1i 4E-V5R WA7 SUITE/IJN1T# ASSESSORS TAX/PARCEL# _ _ _ LOT SIZE(s,f) LEGAL DESCRIPTION(e.g.Acme Estates,Lot I) Tawe*.wearei.paperer waft kgeadobni • PROJECT INFORMATION TYPE OF PERMIT 0 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 onhi) =NtSrritki-er-r-i es F c:eaE s (,-r14 s-rLJ I 4 C.(03 5y�a 5' 04 AR t2( 11-F F. PROJECT NAME(Name of Business or Owner Last Natte) . eAmpus ,LAZA Bt.'t 14). t4 f PEOPLE INFORMATION PROPERTY NAME f PHONE OWNER //�`Y1! a•�•v�11- ( ) - �tAll.HiG Crry,STATE,DP CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE �r*i- MEct4640te-Ac_. (�� )5'7S 75-L7 MAILING ADDRESS— CELL PHONE �us;Ty pO CITY,STATE,ZIP 8 4v rCRY OF FEDERAL WAY BUSINESS LICENSE NUMBER r�,`W 1� EXPIRATION DATE FAX NUMBER -B L (Za6 ) 575 -7sz9 CONTRACTORS REGISTRATION NUMBER(copy of cud required with each appllatiend EXPIRATION DATE S 'r- rg L &Ai Y L c APPIJCANT COMPANY NAME APPLICANT NAME OFFICE PHONE c-rAr� MEccoN._ a stiltL F-44r ,. )S�7$� ' 752.. MAILING ADDRESS CRY,STATE,ZIP CELL PHONE aCUI> {1ACL y +��..: _ O. /alga t ) - RELATIONSHIP TO PR me..T FAX NUMBER ©Architect o Tenant ❑Agent ft Other(Describe) PL.4.4W 5.tT.. {x„06 ) 5.7.S-75-4 9 CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS ( ) LENDER Per RCW 19.27.096: Leader itybratation is NAME required Vfprgject waive a $5.000 MAIJMI ADDRESS CITY,"STATE,ZIP (PHONE ( ) • DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE-$ d VALUE OF u • • c •-, • • $ SPIUNKLERED BUILDING? ❑YES t7 NO F • SYSTEM PROPOSED/REQUIRED? ❑YES ❑NO WATER SERVICE PROVIDER p LAEEH![VhII ❑HIGHLINE .1 TACOMA CI PRIVATE(WELL) SEWER SERVIC. PROVIU R ❑LAEEHAVEN ❑HIGHI INE ❑PRIVATE(SEPTIC) 0 • PRO TEC?: FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED ' t AL S9.FT. S9.FT. Sq.FT. BASEMENT FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE I1 CARPORT 0 NUMBER OF •• . =OM PROPOSED TOTAL TOTAL er -omLmOsae®o TOTALS, .**NEW-s 'ta. ONLY"' NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ FIXTURES Indicate number of each type of xture to be installed or relocated as part of this project. Do not Include exiStbrigfbctures to remain. MECHANICAL Value of Mechanical Work $ AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOODS ccomm g WDODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAB WATER HEATERS DUCTS GAS PIPE OUTLETS S t-{'J" tL PLUMB/NG BATHTUBS(orT,bishomxca®Loi SHOWERS WATER CLOSETS rftwo MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PiPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAYS(Bathoomswoet VACUUM BREAKERS ELECTRIC WATER HEATERS DISCLAIMIER 'SIGNATCRE BLOCK I certify under penalty of perjury that the*formation furnished by me is true and correct to the best of my knowledge,and further,that I am authorized by the owner of the about premises to perform the work for which the permit application is made. /further woe to hold harmless the City If Federal Way as to any claim Anct u>;ing costs,eacpenses,and attorneys'fees incurred in the investigation and a of such claim),which may be made by any person,including the undersigned.and filed against the City oft Way,but only where such claim arises out of the reliance o „,city,including its It/peers and employees,upon the accuracy of the information supplied to the city as a part of this application. NAME/TITLE i'� ebAFk C'"c.ATL. /4/6t4r+ki-Ce G(Z DATE 1.1107 (Stgnahue) [Waal RELATIONSHIP TO PROJECT o Owner o Agent 4 Contractor o Architect o Other FOR OFFICE USE ONLY a NEW ❑ADDITION o ALTERATION o REPAIR o TENANT nipRovnuorr BUILDING SHELL ONLY? a 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? ❑YES es NO PLATTED LOT? o YES ❑NO DEMO PERMIT REQUIRED? o YES o NO Bulletin#100—January 1,2006 Page 2 of 4 k\HandoutsTormit Application