10-102326 •
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email '"p ECE JUN O V U I / G.rire_ / 0 Z 3
Federal Way PERMIT
COMMUNnY SF MF CO ME EL PL DE EN FP
3332587"RVENU I�� ��� P YI CATI O N
FEDERAL WA. 9 0 •97 / / '
255.835.2607•FAX 255-835.2609
v at cti erle0.4luMU_S
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
' SITE ADDRESS-3 3 4 5 g GTH F�
A v4 . S S. 'DAvevit' . /4.>A7 SUITE/UNIT#
Q _
ASSESSOR'S TAX/PARCEL# I 2- iii - _d_ O - D O / LOT SIZE(sj)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal descriplt.N
MI PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
S A?t7 N F/Ra syS 6AS LIl4 M 601 FX 7-11 _F.-PST/Ala.. SPK/Av1cL41+e
- i - , ' .. HAS NFW TEN'9iJT•:
PROJECT NAME(Name of Business or Owner Last Name) /C'/EL i-r P/ejl"C/F/C.
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER FF_P6414 L- kiiity Pie.0/C. 5✓D,IVAL LLG (4.25)2 56 -Ad5 6
MAILING ADDRESS CITY.STATE.ZIP E-MAIL ADDRESS
334-55 (r/t 41/0 . S I FED,ER A L iv 19, 9Rd'9
•NTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
SAI/r# F/45Cyc1 .5: 4 S cO.er Da.Yey (253) 24-g- 2.44-7
((� MAILING ADDRESS CRY,STATE,ZIP CELL PHONE
�v1 //DG 54-TM AvG, Tl�G��/� k 984�A-( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
19-87--ODoo55-Do.. 3L /2/3Z6/6 (233) 92.4 - 2.3 So
CONTRACTOR'S REGISTRATION NUMBER EXP TION DATE E-MAIL ADDRESS
S/y/?h+FS /3G 40 T• /1 OZ./2-0/0 ,COoXEyQSNITHF/ifg.cath
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
5FS ceve U"Xxr (253) 29S-z 4-)
MAILING ADDRESS CITY,STATE.ZIP CELL PHONE
PPO 6 54-TH Ave. E. -i`14Ga A I.v/f' 984'2i-( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
o Architect a Tenant a Agent )(Other DGS/GA' , ( ) -
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT CDT PaXEy (2.S3) 2-4$ - 2-44..7 C1:0XEy(a SMmTNIAlleie.CDA/
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS cmr.STATE.ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE &AiL,.D/A/.sa _5w4E4-4 PROPOSED USE ODIC/CIE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 4-g3 Z./,D O
SPRINKLERED BUILDING? )6YYES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? DYES a NO
WATER SERVICE PROVIDER %LAKEHAVEN a HIGHLINE a TACOMA ❑PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAII.EHAVEN a HIGHLINE a PRIVATE(SEPTIC)