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06-100817 -iii . . 7 '.' - ' '. .A iztee Federal Way PERMIT 1 PER COMIMUNTTYDEVELOPMENT SERVN S�� 1 . y`a a T SF MF CO ME EL PL DEE FP 91325ITU AVENUE 50117)1•POBOX 9718 P�,. FEDERAL WAY,WA 98063-9718 O OEO P L I C AT I O Nfro 253 835.2607•FAX 253435-2 F FEG / / w,m.dtwffederdwaaanCA4. U,�0"- The oNowi • is re• ir+ed i ortnation-an Inco •tete • •.lication will not be acce•ted Please •rint Ie• •1 in in or j ' )I MI PROPERTY INFORMATION p `' , SITE ADDRESS 14-t 5. 3 2t-�' '1` 5tye,� Ei,(�eh,ca ' wA SUITE/UNIT# Rot ASSESSOR'S TAX/PARCEL# i 5 0 © 5 d _ 0 b Y' a — — LOT SIZE(Si) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) µnaafi aeparate page%r Im.g by legal desaiptlm,) M 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 i.rk included on this permit only) r i( S p9._(N) .(,�� K 6:chif)V.CA 6v tE, P ;,elf-r,�•,c , /.moi. ` PROJECT NAME(Name of Business or Owner Last Name) L r i3(Z is T/0 N S( E ` i a PEOPLE INFORMATION PROPERTY NAME PRIMARY PHONE OWNER -1 ar C.h Lnvest {aro p Q S 14.„c, i ( ) - MAILING ADDRESS KIM STATE,ZIP ?o 430/(., 021 CIC I YD -T-V41lit (ii-1241 CONTRA R CONTRA NAME APPLICANT NAME OFFICE PHONE ff� i(YlP AP( I� w Afl+I D`( -2 (�4Zv) 0 - f v CELL PHONE MAILING ADDRESS CITY,STATE,ZIP /20 • CITY OF FEDERAL WAY BUSINESS LICENSE BER EXPIRATION DATE FAX NUMBER CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE 5ititP1, (-- 41)_0e 5G� ) iia / og APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE 140C, vY 5 c M P xC-,2j.I i• el.-1_, K Al 1 0'P---e,h-e--- (Acro)Xi) - Inc K'LINO ADDRESS girtSTATE,ZIP 615 I $ CELL PHONE MI5 20 1 041&PCVQ> ' , I 0 0 T Tl .. VkJ/ (W )730 -1.o2-1P5 RELATIONSHIP TO PROJECT FAX NUMBER a Architect ❑Tenant kitAgent ❑ Other(Describe) (2�.1p) Za I -1S 0b CONTACT NAME , ; A �U t PRIMARY PHONE D' l (ao� �a I t I tc�iaF,c LENDER MAILING ADDRESS CITY,STATE,ZIP • • ■ DETAILED BUILDING INFORMATION • ' EXISTING USE r,�.t a PROPOSED USE ' EXISTING ASSESSED/APPRAISED VALUE $ aya VALUE OF PROPOSED WORK $ —`-7,�tD L 0, SPRINKLERED BUILDING? -YES I�NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? i�YES 0 NO WATER SERVICE PROVIDER 1LAKEHAVEN a IMMUNE NE a TACOMA a PRIVATE(WELL) SEWER SERVICE PROVIDER a LAKEHAVEN ❑ HIGHLINE . a PRIVATE(SEPTIC) 1:3‘.2 a•c Nap r PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT ''FIRST i SECOND / _, v THIRD FOURTH p • ADDITIONAL FLOORS(DESCRIBE) " DECK(COVERED?) GARAGE 0 CARPORT 0 NUMBER OF FLOORS swats!°I' raor°sso(1/ "NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ FIXTURES Indicate number of each type off xture to be installed or relocated as part of this project. Do not include existing fixtures to remain. MECHANICAL Value of Mechanical Work $ • AIR HANDUNG UNITS EVAPORATIVE COOLERS GAS LOOS REFRIG.SYSTEMS BBQS FANS HOODS(CammercLq WOODSTOVES BOILERS •,. FIREPLACE INSERTS RANGESMISC(Describe) • COMPRESSORS FURNACES GAB WATER HEATERS DUCTS OAS PIPE OUTLETS PLUMBING BATHTUBS(or7hb/showercembe SHOWERS WATER CLOSETS(relies MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS I.AVS(Bathroom_ . . VACUUM BREAKERS ELECTRIC WATER HEATERS DISCLAIMER/SIGNATURE BLOCK I cert(fy 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 when 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. �\ ^^' C n NAME/TITLE 6}{3 Q,A�, �11v�.,P.l l�,h1 v DATE •3d' �'(� / (Signature) 'Z (Title) RELATIONSHIP TO PROJECT a Owner kAgent Contractor a Architect a Other 1) p r'01:'t ;ill e.10C:+,t1t(r),t ';:a:4'.-.E.1°,4 t _ -a t' ;f r )(r P 4 . '1,41 ,:)^.7( i V E��1 Q ht (9; r''''''' •k 10AS,a., Z5f)ti6Z4:,1,-J "` ,(9� ( !J tri ).ri Cb,\ 4{i4: • f r e):3,1"( a • NP ;•1:,,`"^,94:.,': ^ ✓.• '(:'' Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Pennit Application