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05-101140 emaF 1 il�C � / (.1-'0Federal Way PERMIT COMMUNITY DEVELOPMENT SERVICES �A A p Y 200 SF MF CO ME EL PL DE EFP 33325 8rk AVENUE SOUTH•PO BOX 97]8 /i f5 1 A f'PLICATION FEDERAL WAY,WA 98063-9718 TD / / 253-835-2607•FAX 253-835-2609 www.cituoffederalway.com CITY OF FEDERAL WAY . The oliowin• is •ui '• )GSonEPT—an incom.Tete a••lication will not be acce•ted. Please •rint le•ibl in in or j• . • PROPERTY INFORMATION SITE ADDRESS -)416 00 215 i AJEot)r. SUITE/UNIT# ASSESSOR'S TAX/PARCEL# 5 4 L- 35 0 - b S 0 ©5 LOT SIZE(sf) LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal description/ IN PROJECT INFORMATION TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING [f FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) Ac)" LIRE 5191'-INKlEQ,5 Tc �-.< t 7tfJ44Sysr6"il FOR ADDED Se)FrliS PROJECT NAME(Name of Business or Owner Last Name) AD¢.'TIN I j ( 614vICC l l • PEOPLE INFORMATION PROPERTY NAME PRIMARY PHONE OWNER NoRill wEi7 CNSact-) ( ) - MAILING ADDRESS CITY,STATE,ZIP 34Sr .Z-1 5T- AV€i.lui. 1:1Ob(LAL. L3 Ay / (A;A Cii6 b 23 CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE (Vwetl, CA,t-1.7 s'ic -\ VcvW �saaJ ( L53 ) l L ?X22 MAILING ADDRESS CITY,STATE,ZIP CELL PHONE 75155 S4. Zocrr14 4i YeN�, tAA ° o3% (a6c,,, ) 4,'79 - Sc12 CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER 2. 0 -0 O -i b 1 4_ (o B i c / of / &5 ( 153 ) 4,0Z - 1177 CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE A (- C- AA 6 1 4 2_ 1 cl s 0 q"/0 i /C7 APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE �J'4.^e 45 i`A ISPn,' ( ) MAILING ADDRESS CITY,STATE,ZIP CELL PHONE SAME A5 A30vc ( ) - RELATIONSHIP TO PROJECT FAX NUMBER 0 Architect 0 Tenant 0 Agent 0 Other(Describe) ( ) - CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS 4-‘)/4 (A)11.-5C4 (2.53 ) 4i 7'i - 7 a key e.-A"-)eQe...645igu,rro LENDER NAME '4.1 ,P*r; 13t tf it a information is . �s ect ,a,$5 000 N/A MAILING ADDRESS CITY,STATE,ZIP • DETAILED BUILDING INFORMATION EXISTING USE C..w.Cc-t1 PROPOSED USE w .,.. EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ ZOO SPRINKLERED BUILDING? `(YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES te NO WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE o PRIVATE(SEPTIC) .i S PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST %TS SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE ❑ CARPORT❑ NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTI G6P TOTAL PROPOSW NP lOT S4S ; **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 FANS HOODS(commera7( WOODSTOVES c; BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS(or1Ub/shower Combo( SHOWERS WATER CLOSETS(Toilet) MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS(sathmom 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/TITLE DATE 3/ (Signature) (Title) RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent Contractor 0 Architect 0 Other o ADDTT QIxt r ALTERA'T`ION o REPAIR ❑TENANT IMPROVEMENT " ®YN(I 3�IllElr p �I �'ES a NO ; ? '74NINrJ)j I� o d yr � ,„, ;t CIEsI�UI :, F "\ D? YES a NQ UR/SEPA/SU? •yi d ro F PF.ft 'i Imo? a BYES• a.NO DEMO PERMIT REQUIRED? DYES ci NO•_ Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application