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07-101027 -. Fererai Z oo� PERMIT ' h�� COMMUNITY DEVELOPMENT SERVICE c�'1 Z MF CO ME EL PL DE E FP 33325 D AVENUE SOUTH•63 XW�a�r- P P L I CATION FEDERAL WAY,WA 98063-9 Pk„ Tp 253-835-2607•FAX 253.835-2609 ,c..00)% �00�4p / / unow.dhIo Tederolwau.ann [f The following isl'egi d information-an incomplete application will not be accepted. Please print legibly(in ink)or type. S PROPERTY INFORMATION� o SITE ADDRESS 7-Cl 0( t i Z3 .• 7t4 7C cLxa WP (©23 SUITE/UNIT# ASSESSOR'S TAX/PARCEL# 6 ( 2 ( 0 3 - eL — � OT SIZE(sf) LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) (Attach separate page far lengthy legal desnipti ni U PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING pp FIRE PREVENTION SYSTEM PROJECT D C PTION (Prouid detailed description of ork included on this permit onh,i) ` -i. 447,1 �� j:5/ �i r permit c-- s' 6 I PA /3 D PROJECT NAME(Name of Business or Owner Last Name) C!( (/14.d✓y (k , PEOPLE INFORMATION PROPERTY NAMEI f_ PRIMARY PHONE / OWNER KVt tar'\ ✓. r -ifv o✓i L I 12e 7 i k, C e (25y) qoS -3f 6 MAILING ADDRESS 7 CITY,STATE,ZIP E-MAIL ADDRESS CONTRACTOR COMPANY Np E APPLICANT NAM a � _ � OFFICE PHONE - E i .4 vlik ( ) MAILING�ADDRESS y 5 CITY, E, IP c7�� CELL PHONE CITY SZ FEDERAL WAY BUSINESS 5LIC - k•EKI NUMBER kAi i XH[RATIO DATE927/ F .( 2O ) zoo _ewer _ ER (FAX 1 —�53 COPY of card rcgnircd CONTRACTOR'Sys REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS with eae applleatlon a^-� I /7 l2/-Ct-474(11-Tj t/-1/-OFr5 c U 041CO APPLICANT COMPANY NAM; APPLICANT NAME wic, OFFICE PHONE MAILING ADDRESS CITY, ZIP "01 CELL PHONE /5(5Z. 6G e s ,Z/ (z') ZOO -60/ RELATIONSHIP TO PROJECT FAX NUMBER[�u[� 0 Architect ❑Tenant 0 Agent ❑ Other 19 �"r + +A. Com". (9e& ) -I-17 -13 . PROJECTNAME // J_ PRIMARY PHONEr E-MAIL ADDRESS CONTACT letit6 , �/ 1era /yG ( c3 ) ‘f0; W61 LENDER NAME 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 PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ -7J3C-6 SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ;FT: SQ.FT. SQ.FT. BASEMENT FIRST /7 SECOND THIRD i/ ADDITIONAL FLOORS(DESCRIBE) DECK(0 COVERED OR 0 UNCOVERED?) GARAGE 0 CARPORT 0 - I EXISTING I PROPOSED I TOT TOTAL EXISTING Sl TOTAL PROPOSED Sl TOTAL Sl NUMBER OF FLOORS **NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ FIXTURES Indicate number of each type offixture to be installed .r relocated ••part of this project. Do not include existing fixtures to remain. MECHANICAL Value of Mechanical Work $ (A COPY OF'BID OR ESTI b•TE MUST BE INCLUDED WITH APPLICATION) AIR HANDLING UNITS EVAPO' •TIVE COOLERS GAS PIPE OUTLETS WOODSTOVES (Describe)FANS GAS WATER HEATERS MISC( ) BOILERS FIRE'LACE INSERTS HOODS(commercial) COMPRESSORS FU' ACES RANGES DLJM GA' LOG SETS REFRIG.SYSTEMS PLUMBING MISC(Describe) BATHTUBS(or Tub/Shower combo) LAVS-(Bathroom Siniks) U` NALS DISHWASHERS --RAINWATER SYST VAC M BREAKERS DRINKING FOUNTAINS SHOWERS WATER -4S oueq ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBS 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 flied against the City of Federal Way,but only where such claim arises out of the reliance of the city,including its officers and emplo yes,upon the accuracy of the information supplied to the city as a part of this application. / • ��j • / �/ , G— / ;, � DATE NAME/TITLE _ / (Title) �` (Signature) W RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent 0 Contractor ❑ Architect 0 Oth li • o NEW o ADDITION 0 ALTERATION o REPAIR 0 TENANT IMPROVEMENT. • BUILDING SHELL ONLY? o YES ❑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 1 Page • 2 of 4 k41andouts\Permit Application Bulletin#F00—January l;2007 •