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06-101845 • ECE%V - Clrr OFderal Way Fe = • �R R 1 2 2006 PERMIT COMSF MF CO ME EL PL DE EN COMMUNITY DEVBLOPAfENT SBRV! Go 93325 8171 AVENUE SOUTH•PO BOX 9718 FEDERAL WAY,I X 223-63-9718. P LI C AT I O N 253.835-2607•PAX 253-s�Tpq/OF FEDERAL ; #10 ,ww.dtwfedcmhwl°..ojin BUILDING DEPT. The followin• is re• ired information-an incom•tete a••lication will not be acce•ted. Please •rint legibl in in or type. ■ PROPERTY INFORMATION SITE ADDRBSS 22� -5 A -3 SUITE/UNIT# ASSESSOR'S TAX/PARCEL# T Z- Z e - C' �% --. LOT SIZE(sj) 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 ,I�FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu) , \ �-- s fi \ `�. 1;70-r`e'S'�/ t�,•. S• � Gr o o ff( PROJECT NAME(Name of Business or Owner Last Name) (24 L' t )y'- -- IN PEOPLE INFORMATION PROPERTY NAME (� �/ PRIMARY PHONE OWNER r7 /- dL" ) MAILING ADDRESS CITY,STATE,ZIP CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE to 04- Frt,t,Q esti -�is/v L (4 —etr,(7z- A (2,46 ) 71? 3 Q MAILING ADDRESS CITY,STATE,ZIP CELL PHONE 37 t( S,f vci(9e r-1- 3r 6 .S-(caddi ` l(8° (?)6 )38dr -8(2-3 CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER B L / / ( ) CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE ° T � & P ./ c/ 7a 0 / ©5 !Zoos APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE S c-- S Cvw % ( ) MAILING ADDRESS CITY,STATE,ZIP CELL PHONE ) RELATIONSHIP TO PROJECT FAX NUMBER Cl Architect ❑:Tenant ❑Agent ❑ Other(Describe) ( ) - CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS llcZat.T1='z A— c2dG.) 723 - LENDER .;r f rZ at s; se MAILING ADDRESS CITY,STATE,ZIP I PHONE ■ .DETAILED,BUILDING INFORMATION EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 2 ZOO•, 0 SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?)YES a NO WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER Cl LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) o • PROJECT FLOOR AREAS AREA DE ION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE 0 CARPORT 0 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. ifEC,&AIVICAL Value of Mechanical Work $ AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOODS(Commerelet) WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING • BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS troaey 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 certljy 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 authorised 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 DATE (Signature) ride) RELATIONSHIP TO PROJECT O Owner a Agent a Contractor 0 Architect a Other • nlo s� rl 7 3 ?,, .3f4 r . .�ti :1171.•. :a .ti 1 {�1_ � • 3 a JC.C, 95 '© ' r, ,: � �... A'�'� !FR-�'' ? fit 5io` n..na.:.a 4 1 AA_Tea.uora.1 9AAV PROP 9 rf d k\Handnuts\Permit Annlication