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06-101439 CITY OF ° R 4:?E l M ELL ( 21L . '.- Federal Way PERM I COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE EN FP 33353-83 AL WA FAX?98 18 5 8Th AVENUE SOUTH•PO BOX 7I8 A P P LI C AT I 0 N'4 4 20 graFEDERAL WAY,WA 98063-9718 TO ttnuui.diuo ferleroltuatt.rnm CITY OF FEDERAt-N41 i ) RR �� ppINC�DEPT. --j The following is required information-an incom•late a••licatiovrIUnot accepted. Please print legibly in in or • . NI PROPERTY INFORMATION SITE ADDRESS - k---r-T;PI0‘ • • SUITE/UNIT# ASSESSOR'S TAX/PARCEL# , _5 () L 1 - v \ I) LOT SIZE(s,fl LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal description) !♦ PROJECT INFORMATION TYPE,OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL • 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) Y �1.o -Eve \�Y�P \ � a�.. �; ; Y' : t\ .�- . X-it \ . PROJECT NAME(Name of Business or Owner Last Name) „At4t.z.5 Butt.( .-1(y PEOPLE INFORMATION PROPERTY .NAM 1 PRIMARY PHONE OWNER II1$Tid\ C-11 1 �� � Lit --).."4101• CTTYPa�'itt c YT. —c- (. )(\al t - - CONTRACTOR COMPANY NAME • APPLICANT NAME OFFICE PHONE ' 1;)11t-‘ rItE 1C�Fk -A D`'V\�(- 'J\. A \\( ( ?-wt) CITY/�TAT ,ZIP �'1Q7T' CELL/PHONE G,�F FEDERAL'c,) LICE NUMBER, V `�� 1RATI0 DATE N FAX NUMBER) 1CI -a\ L -A > 1 Is -B L ' / / t 11�' r AS2eb CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE alliittRi;--Ve.,Vl itC.,' 1t\41C• C1\ �i,i(y (- - - -(%y,tS CrTY, A ZIP CELL PHONE' aLATH)NSHIPTOPROJECT -n( '11 , C15 F B FAX NUMBER 1 0 Architect 0 Tenant ❑'Agent ❑ Other(Describe) ( 1)(4-3.13L- 11\t•__U4- CONTACT N PRIMARY PHONE E-MAIL ADDRESS \\ c \\ ( - 673(1. - - 0 okkk e� ; ire., , LENDER ' Xa AYr,a°�314C4A404f "".4' OrA9t�a ��''��`,�Y ' = .. NAME MAILING ADDRESS CITY,STATE,ZIP PHONE ( " s,•::‘!:; DETAILED`BUILDING:INFORMATION "' //MISTING USE \A.c&J5I Pel,— PROPOSED USE `JArM. - EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 146.SCC) . SPRINKLERED BUILDING? *YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER o LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC) II ID PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL • SQ.FT. SQ.FT. SQ. T. BASEMENT FIRST SECOND li \ tc 43 �c larks THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE 0 CARPORT 0 =ST= TOTAL ,t't1�; tau'..,-C.( C ?d��6A NUMBER OF FLOORS **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 $ AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FIREPLACE INSERTS FANS HOODS(comaras) WOODSTOVES BOILERS RANGES fcl COMPRESSORS FURNACES GAS WATER HEATERS ,gyp BOILERS DUCTS GAS PIPE OUTLETS -��� PLUMBING BATHTUBS tar Tut/sno.Krcomtot SINKS SHOWERS WATER CLOSETS(Toilet) MISC(Describe) DISHWASHERS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS(Bathroom s,Jre) VACUUM BREAKERS ELECTRIC WATER HEATERS DISCLAIMER/SIGNATURE BLOCK I certify under penalty of perjury that the info>mation 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 ho 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 ase a part oldf this application. NAME/TITLE fes/ DATE 3 --7—Lk—0(—P )Signature) (Title) RELATIONSHIP TO PROJECT U Owner 0 Agent pc Contractor 0 Architect 0 Other r ✓�. �" ,� � 3 r I r�SV sr ,� a \1p !b9'P e .It �'x..-�� ��i 13 i:i s 4 xb H Q °4 6 Si �,.,,� 6,%'i ,y ,4� ::1-1 ?-;-'''''W•,..;-1,-," � 1 s 1,,'ap' ti6'� � r =,,:q ,Y „11(111-%,,,, } 3 � a,. ^4('. , '$..i Qz Gi ti-.sa I i i,,,. ., L� ;:t4 a 4 t' .. 6, 11,E�” � "s:;t � 1 �� r5 1 ''''''';'::',?1--'1:-7',.",, }A � .. 1"--,,'K"'7,-,,(14,.4? y �-, c ..Fr.,n c� 7 haz.r�' P"'z �M s�,��.+�. ®g�:'�'g (D ��y o (R 1- - '� 1' i �r �'z r, t 1 4 �"' ., 0,,,, 9 1 4 . s , t 2:>s, .v°.:„14,11L.""1,74,414 k ,Tigi„��:i,,' ut ©P • .4 ni r's...441g� � �� JY& � ° � �'�?.aF���i�.�'�.� �Ar�a�mia6kat f �^.�, 1 .� I4zr� ,a 9" .CUs �'t �, .uu e ° � �swa5..�w ���� .:. ,.. _s k*.-,M. 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