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06-104011 RECEIV le• AUG 1200 . \ V \-77 0 — /a OL L FederaCITY OF l way T?of FEDER? RM IT M COMMUNITY DEVELOPMENT SERVICES �,1 Bu1LQ'��1� SF MF CO ME EL PL DE E 111 33325 8TH AVENUE SOUTH•PO BOX 9718 APPLICATION rm FEDERAL WAY,WA 98063-9718 / / 253-835-2607•FAX 253-835-2609 www,ctRoffederalwau.com The ollowin• is ret uired i ormation-an incom.lete a r r lication will not be acce.ted. Please •rint le.ibl (in ink)or •e. ��pp • PROPERTY INFORMATION SITE ADDRESS `-wZO& 't. S w / . - ' T r / SUITE/UNIT# ASSESSOR'S TAX/PARCEL# Z I S y t* S - Cr) O 7 0 LOT SIZE(sf1 )713.a LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) L01- ( E.L,.,1C .pv.5 CL,(e p w k Ptav,_z-t ( • RaL._v,1zSI it (Attach separate page Jor Lengthy legal descrtptton) .. V 1'.t.�. tri( ,c 't,,:ks P. . . 3 c k,.., C., P. c .Jds IN PROJECT INFORMATION TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit onli)) B Itn-c U Ptr ¢ ( 1,-...:...1 �Fv,i.,� DOC ill 40... (li,.t lA,.ht0 A t>( LA C bm, .(( F•cc- , —t L bL&j 1 (Ilv t� PROJECT NAME(Name of Business or Owner Last Name) EASY 2 r 1,STei! I-tec . WT a T3,(IS 6- A • PEOPLE INFORMATION PROPERTY NAME t( PRIMARY PHONE t� OWNER Pain C,�3'^ . (fib )?-1-ib e,SSS MAILING ADDRESS CITY,STATE,ZIP M o o c.,-1/41-L,_ec.w-e- per'! i. P 9sg1 eig �wc. SO D.- CONTRACTOR COMPANY NAME APPLICANT NAME rI OFFICE PHONE Arc. — Cn..-.5 -v-- --• ' 1 t Dut3A41, - (A3 ) `d7- - -12- -,)- MAILING lMAILING ADDRESS CITY,STATE,ZIP CELL PHONE /SC'S S to6-(-l_, S+• kkvk W\ 9go 3a (,)iC ) 67( -52o2 CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER - - - / / (2S3 ) �7� 7. 77 sl CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE / / APPLICANT COMPANY NAME 11-1.0,e_ APPLICANT NAME OFFICE PHONE SA w..0- et., ( ) - MAILING ADDRESS CITY,STATE,ZIP CELL PHONE ( ) RELATIONSHIP TO PROJECT FAX NUMBER ❑ Architect o Tenant o Agent ❑ Other(Describe) ( ) - CONTACT „N_AMEPRIMARY PHONE E-MAIL ADDRESS i°'�•'. z., PRIMARY (J0 Y G63 ) q 7 -7a D,)- --Av,,-.(<.;ckt.tlt,Cc..s�ru:crfie.n, LENDER Per RCi9`%I9 04,er,Yet i"cirfrilution is''-- NAME required ifprojectWAte eaveds';$5 000 MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) • DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ )cjr O 0 C7 R SPRINKLEED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? n YES ❑ NO WATER SERVICE PROVIDER n LAKEHAVEN n HIGHLINE ❑ TACOMA n PRIVATE(WELL) SEWER SERVICE PROVIDER n LAKEHAVEN n HIGHLINE ❑ PRIVATE(SEPTIC) • A • PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE ❑ CARPORT❑ EXISTING PROPOSED TOTAL TOTAL EXLSTNG$' •TOTALPROPOSED eS TOTAL$F NUMBER OF FLOORS • **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 $ AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOODS(commercial) WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS(or Tub/mower combo) SHOWERS WATER CLOSETS(Toilet) MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS(Bathroom Sinks) 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. / (( ��`` f 4.-3A( / /' NAME/TIT l `fl /" � u�A �s7C:�dcr.a�-- DATE Ol/�(/0b ign ture) (/ roue) RELATIONSHIP TO PROJE 0 Owner 0 Agent x-Contractor 0 Architect 0 Other ❑NEW a ADDITION 0 AL a' d:Lif,, 0 REPAIR a TENANT IMPROVEMENT BUILDING SHELL ONLY?'' p q Nth•, •,i „BASIC PLAN? w a YES; a NO ZONING DESIGNATION CHANGE OF USE? a YES', ©-NO "" NEW ADDRESS REQUIRED? a YES 'a NO UP/SEPA/SU? a YES' a'NQ PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO I Bulletin#100—January 1,2006 Page 2 of 4 k\I-Iandouts\Permit Application