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05-104217 ' 4 RECEIv ' CITY OF Y IP COMMUNITYDEVELOPMENT - / ° V / Federal WaySERVICES AUG 1 9 2005 PERMIT I 7 3353oFIRST WAY SOUTH•POBOX 918 PLICAT ON FEDERAL WAY,WA 98063-971,g1TY OF FE©ER SF MF CO ME EL PL DE E P J • 253-661-4115•FAX253-6614129 1�1It �(C'rD www.cityoffederatway.com Bp �— T•kb'C-{ ,.. (,(1„_0(2) oo(ole. (r 146 The following is required1�/information(� -an incomplete" application will not be acce,ted. Please •rint le•ibl (in ink)or •e. • PROPERTY INFORMATION SITE ADDRESS a S o0-6:" W �J Scl r% J Ir-Clu c e ctuto_SL C-,.)G-,,- t/,3( cti b g-- p SUITE/UNIT# { b1A-TA-J1-Q A cid I h DA-S 1 / CJ ASSESSOR'S TAX/PARCEL# 1 0 -J - L t/ 3 4 LOT SIZE(sf) LEGAL DESCRIPTION(e.g.Acme Estates,Lot i) (Attach separate page for lengthy legal description) MI PROJECT INFORMATION TYPE OF PERMIT ❑ BUILDING ❑PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING /4 FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) Adel C)el +1 t a ,r1,.0.,_.- a.b,,,_Aoli roor,-, poy''ft Lt ,...kb t—h'ipe.„., 60,..,_0-D I c.,vet A'l etwvv ,1 w ,114-10-0) . Tie-e p - o1.K f'40 to a-lt es h rt.el, 4o ao N-tit ►tial C.6.ay.A&eP &N t'r161-rt II r, AA, K A1 Aix)r1 a N Pc(, P,a,v..I.Q ft' pc y ice-o Le .-(rr 51' CA.n,Cua- o , Coy.' c.,t 90Y2t( 7 to PA l e Pio Hap-p-Lek C,:/Lt c,t�-k etv.d A NAC E 44.146,-,`i pa -Le 6y- Plc JE�v ;TeLQ .I N , N✓Vv LL .' A' c G "... . Gry �uC�rv-Lia� ltd I✓l -w ppet 0 Le Sfr1.d1W .t�Yl l ✓ -.A- / (Name of Business or Owner Last Name) oec-AT IA (L H i(i H 5Ct-1oc)L, P12r n6Le, r\tN)ill ON3, • PEOPLE INFORMATION PROPERTY NAME QGQL ( Pld�L ' FIUS n l � PRIMARY PHONE OWNER (Z,q -o-vvD MAILING ADDRESS , ZIP . )-0405 \61(1\ 17. le Mk 1WS _ CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE Svu--e(7Ow-cl ke,-, c-r( c., D' 12e -, tw (?,64) ��) ;i'l? MAILING ADDRESS CITY,STATE,ZIP CELL PHONE -'c 6v4_ 51.0? G= VLew,f- v.1 Pc !'t q"J"?,Z ( ) - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER 1 °L-nQ -1a 1 q�-BL t2 / -3l / o5 ( a0S7g --/w7 CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE 5 "Le. PP t-) e5 Loa a -7 / 31 / o7 APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE `'),r,,plA C,r,,,,-..._..Q.-ZR &t-GL 0'R€J C (a°to) 111 - okay MAILING ADDRESS CITY,STATE,ZIP CELL PHONE at D 2OO t D 4`. Av'e, S. # t trD Se-o *Ci-- w °iS l o S ( )ail l - t oto 8 RELATIONSHIP TO PROJECT FAX NUMBER 0 Architect 0 Tenant 0 Agent [ 'Other(Describe)5" (-o tD) al( - 1S DV CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS KA 4-k; D'( .ear Farr-S,w-etwenn,v.e.Q"_f (aetc)c1ai - t-t-t1� ,5 KNeercwevtesoc�iideoivkr. Caws LENDER �'1- J. Per RCW 19.27095: Lender information is NAME y requiredlifproject value exceeds$5,000 7 l' MAILING ADDRESS CITY,STATE,ZIP - • ��X'l 4?1,N •DETAILED BUILDING INFORMATION EXISTING USE Sc kL0 0 t PROPOSED USE Sit 0 0 1 Q EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ o(q-1 67) III 4111 '. WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT SQ.FT. BASEMENT FIRST / 7 SECOND ..-- THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE ❑ CARPORT❑ EXISTING PROPOSED • AL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF NUMBER OF FLOORS **NEW HOMES ONLY** NUMBER OF BEDROOMS ESTI it TED SELLING PRICE $ FIXTURES Indicate number of each type of fxtur•to be installed or relocated as part of this pr. •ct. Do not include existing fixtures to remain. MECHANICAL Value of Mechanical Work $ 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 BATHTUB.(or rob/shower combo) SHOWERS WATER CLOSETS(Toilet) MISC(Describe) DISHW: HERS SINKS DRINKING FOUNTAINS GAS ' PE OUTLETS SUMPS RAINWATER SYST W I.HING MACHINES URINALS HOSE BIBBS •VS(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. NAME/1Tf'LE a�'• °'( -114;411 f `�`ft� "�Y`A r\—ta DATE 5•v't • )5 (Signature) (Title) /��i RELATIONSHIP TO PROJECT 0 Owner ,(Agent 0 Contractor 0 Architect 0 Other 5" C'A(` �hJ{ Fri 5?"4- rort-v el- k) FONEW ❑ADDITION R OFFICE USE ONLY D ❑ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? opYES ❑NO ZONING DESIGNATION CHANGE OF USE? n YES ❑NO NEW ADDRESS REQUIRED? D YES 0 NO UP/SEPA/SU? ❑YES NO PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? D YES o NO Bulletin#100-March 30,2004 Page 2 of 4 k\Handouts-Revised\Permit Application