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05-106339 RECEIVED _ . A cr 'oFIII ._.., Federal Way PE R M I '~ z 3 ?Q05 . 4 Ls ____ COMMUNITYDEVELOPMENT SERVICES v SF MF CO ME EL PL DE E FP 33325 8T"AVENUE SOUTH•PO BOX 9718 E RAL WA i� FEDERAL WAY,WA 98063-9718 A P P L I C A '* ®Ef T. TD / / '411111.1253-835-2607•FAX 253-835-2609 www.cityoffederalway.com The ollowin• is re.uired in ormation-an inco •fete a••lication will not be acce•ted. Please •rint le•ibl in in or •e. • PROPERTY INFORMATION SITE ADDRESS 2.200 . f5 3ZOT~ S _ �rSUITE/UNIT# ASSESSOR'S TAX/PARCEL# Z 4 Z 3 - C) - Q 6 is"- 0 LOT SIZE (sf) LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) (Attach separate page for lengthy Legal descrip6on) • 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 onlu) f'rD 0 uro0 re-An C 4.#'. r r%nide.r i've43 S it> c.ccd. kiNA_e act4-e, PROJECT NAME(Name of Business or Owner Last Name) -eq..\a 0 U)e)r 16 • PEOPLE INFORMATION PROPERTY NAME PRIMARY PHONE G��PQny OWNER �rtk -Da 1 f,\c. (253 ) 5'f - 20470 MAILING ADDRESS CITY,STATE,ZIP 9 C 0 S '3 2-14 a s cacke o x A- 4$ 4 99 CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE IThRe- C1ST-evls W e r- S,v-t Turk ( .2s3 )83 3 - 124 S MAILING ADDRESS CITY,STATE,ZIP CELL PHONE 21ck •Fro•ti-ye ta. 'J #6 P4CtFt . c 4g041 ( 2s3 ) 202_ - 70l9 'TY( FEDERALAY$USINESS LICEENI MREXPIRATION DATE FAX NUMBER CI ys- ci' CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE APPLICANT COMPANY NAME . �Ic�APPPLICANT NAME OFFICE PHONE 4 Prim (. Prime. A-5 (.....DAA-r4 c 1 L ( ) - MAILING ADDRESS CITY,STATE,ZIP CELL PHONE ( ) RELATIONSHIP TO PROJECT FAX NUMBER 0 Architect ❑ Tenant 0 Agent Other(Describe)Co' 4-t.4 L s©� ( ) - CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS ( ) - LENDER Per RCW 19.27.095: Lender Information is NAME required if project value exceeds$5,000 S' ., F }r i&lance MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) - • DETAILED BUILDING INFORMATION P EXISTING USE - -ret ,\ PROPOSED USE CSE_C)(�,r kst EXISTING ASSESSED/APPRAISED�/ VALUE $ t3 1 //J- 2 VALUE OF PROPOSED WORK $ el Jl 00 0 SPRINKLERED BUILDING? )b7 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?)YES ❑ NO WATER SERVICE PROVIDER X LLAAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER LAKEHAVEN o HIGHLINE 0 PRIVATE(SEPTIC) 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❑ NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL COSTING SF TOTAL PROPOSED SF TOTAL SF **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. MECHAIVICAL Value of Mechanical Work $ 9 31 CiND 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/Shower Combo) SHOWERS WATER CLOSETS(Toilet) MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS fit-S- Spr.,Asc-t.e r 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 i NAME/TI ` DATE 2-- 13--- b3 Signature) (Title) RELATIONSHIP TO PRO ECT ❑ Owner ❑ AgentContractor ❑ Architect o Other FOR OFFICE USE ONLY a NEW a ADDITION o ALTERATION a REPAIR o TENANT IMPROVEMENT BUILDING SHELL ONLY? o YES a NO BASIC PLAN? a YES a NO ZONING DESIGNATION CHANGE OF USE? a YES a NO NEW ADDRESS REQUIRED? a YES 'a NO UP/SEPA/SU? a YES a NO PLATTED LOT? a YES ❑NO DEMO PERMIT REQUIRED? a YES a NO Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application