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05-105291 N 1 a—�d i V l I 0 , ,e,. _ OCTzao0 — C;;) ( 1- ri Federal Way PERMIT SF MF CO ME EL PL DE E, FP, COMMUNITY DEVELOPMENT SERVICES CITY OF FEDERAL W A 3.132F5 8TH AVENUEEDERAL WAYSW ount 8063.9•PO977X1 9718 A P P L I C AT I �: ING DEPT. ° / �"`-_ / - 253-835-2607.FAX 253-835-2609 www.cif yofederalwau.corn The ollowi • is re•aired in ormation-an loco •fete a••llcation will not be acre•ted. Please •rint le•ibl in in or .e. 0 PROPERTY INFORMATION SITE ADDRESS Set 3 `c(►^' Ft C (4 c SUITE/UNIT# ASSESSOR'S TAX/PARCEL# - _ — — — LOT SIZE(sf) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for Length/legal description) . :;' ■ PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING : MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERIN( p IRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) • 4 art iZa .1 - cr- O3ii a... 7't"At': Ar.,.. Vim. bill -" /Sria-M - &.--7 7/ ii--- 16?-,:. /a-c-7 1 PROJECT NAME(Name of Business or Owner Last Name) �e'�- try_RA'" PEOPLE INFORMATION . PROPERTY NAME //A� PRIMARY PHONE C OWNER -M) `:t v �rA N, c -c?---1)g38---4,2758 MAILING:)-1ADDRESS$o. / 4CITY,STATE,ZIP-p, --0c\) 70,,:y , 'W 9S3 66 (4 CONTRACTOR COMPANY NAME i • APPLICANT NAME OFFICE PHONE MILINO ADDRESS CITY,STATE,Z[P CE L PHON ei-3--- -TT1:) 300.0E -- . .2 - T f i - S l.-e . pz�t-zt ov_- ( 1 arl OFDERAL WAY BUSINESS LIC NS NUMBER EXPIRATION ATE FAX NUMBER / / ( 1 —B L 1 CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE / / APPLICANT COMPA`NNY'NAME ��[ APPPjLLIIC�Ay�NT NAME ��- OFFICE PHONE CqkA ILL G ADDR SS ID tAdt� ` © � CITY,STA IZ P" -'Z; CELL PHONE Ac-\1r -- LA) t- ') (n) t ti 1 (- n LATIONSHIP TOP WELT FAX NUMBER / 0 Architect 0 Tenant A.Agent 0 Other(Describe) ( ) P11f Cr "J CONTACT NAME � � PRIMARY`PH� - ^ ��� E-MAIL ADDRESS M ` ( / % (! l G4.JJ66]--C.1/ LENDER :,z"s / fr,, r;Y , 4,4.17M7e *17, : NAME c :i--L MAILING ADDRESS CITY,STATE, IP 27`2-1© ] r freA t ei-v`) "te-'' (A) ' '• t": , . i is DETAILED BUILDING INFORMATION •. • EXISTING USE ,1"X PROPOSED USE 6d EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ , (f SPRINKLERED BUILDING? ❑ YES ® NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? to YES ❑ NO WATER SERVICE PROVIDER EI LAKEHAVEN a HIGHLINE a TACOMA a PRIVATE(WELL) SEWER SERVICE PROVIDER a LAKEHAVEN a HIGHLINE ❑ PRIVATE(SEPTIC) f PROJECT FLOOR AREAS ,,N; • AREA DESCRIPTION EXISTING PROPOSED TOTAL BASEMENT SQ.FT. SQ.FT. SQ. FT. FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE 0 CARPORT 0 NUMBER OF FLOORS I EXISTING PROPOSED roru °T:19, ( y aa,arr v �, t r , PROPOSED F:< i. •M`��r07'Ati 6r **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. MECHAMCAL Value of Mechanical Work $ /�_-:-lljy"- :ice L`" AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS BBQS REFRIG.SYSTEMS FANS 1 ( HOODS(C7rnerag) WOODSTOVES BOILERS ,„ FIREPLACE INSERTS COMPRESSORS FURNACES RANGES _ MISC(Describe) DUCTS GAS WATER HEATERS GAS PIPE OUTLETS PLUMBING BATHTUBS(or Tub/show,rcomho) SHOWERS WATER CLOSETS crone) ) MISC(Describe) SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS(Bathroom Snks( 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 22.1k1°''' . fj �?�� ure) DATE (Title) (Si az1�_o.'� �_•z—— RELATIONSHIP TO PROJECT ❑ Owner j Agent ❑ Contractor ❑ Architect ❑ Other t' 'R'®ez® n t r ®sz' s � §',. l -li ® (' ''3: s ,.a r3 �® y a: r'E '. ;Y'° , 4 A:r u u?2 _ ,wM 'rr� 'Rmw rii"*a»»... ra, �.,..,r r,.x: s>nYw^�h.'s... .n.':���i>a - � { 4�I.f h �` 3 n 1 1 ® _ ,,,�q �" Ott ® 4^, ®��` 'r4"'�.�" tC ,'L�'7 `1 ra. Q��"�`m4 m ° '.., _ ., ,. ,1k.'..:.,es u-s�.uvb " ' .tiro.:;: r ' . ,e044 ,� ytr --v- r� I 2.Ar '-`174 c +® ® � si _tnt7-rf''�s5a.X- . r ,S'y�4, !sxF.' . 'r'A3ir5,'La} iw ri:s'—..rs. , :w1,; '. � � ��� �,� ��� O G� 1 E �w��r �P� � � � g,•'� � I1�Ob�.„i �`��`�, „# � ® ii m� -.,! 6.1 1 B .,,�1F'(, a ka® ` ' ?� P' xt a,x /i FPA j. ""a d 'w w" ra l ® r' a,xr rny;. ..��,. �7.4 a'�� q.,'� Y'�ef"� .. �'%���SU 'S�"y..���i ''''''''' '''4444A.;..7,-: 4-i E �y. `p��.R ® u �''�. k\Handouts\Permit Application Bulletin#100—January 7,2005 Page 2 of 4