06-102054 • •
3
CITY OF
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Federal Way PERMIT
S.COMMUNITY DEVELOPMENTSERVIc4 R 2 5 2001 SF M', CO EEL PL DE EN FP
3332E D AVENUE SOUTH.63 BOX 971 p L I C AT I 0 N4._______:apvt,,FEDERAL WAY,WA 98063-9718TB253-835-2607•FAX253-835-1609 OF FEDERALU1wl4nocittto((ed—hanycom aUILDING DEPT. ,/
The following is re•aired information-an inco .Leto a plication will not be accepted. Pleas:print legibly in ink)or fffpe.
■ PROPERTY INFORMATION
SITE ADDRESS 3 4 5 / 'T N v Inti IN/1 e.'_ c4% . SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# ''c 0 4-- -;-_t_ - __OC*1 rZ Q LOT SIZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ 'PROJECT INFORMATION .' '•
TYPE OF PERMIT li;i1 UILDING GriSTIMMir MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION���� (Provide detailed description of work included on this permit onlu) /y
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CA uric-\� V (.• c" t`Q�G_.—( .V r .,a/1"call
PROJECT NAME(Name of Business or Owner Last Name)
fs
• PEOPLE INFORMATION •
PROPERTY NAME PRIMARY PHONE
OWNER FiZ P.4.,...\- C.L 5 c: JJ .- i.--I._" .. i'i 4 'S a••5 —2.:=7,--f (2-5,3) 4.Z -4 t O(
MAILING ADDRESS CITY,STATE,ZIP
1717 n. T" 5-riz•L=ter- t t> c r-r 64, c,.-`A `x'634 c3. - 4-cr3 3
CONTRACTOR COMPANY NAME APPLICANT NAMp OFFICE PHONE
Sk.a 1/ ,c _ nJ:/''>' * ." 3 t f') ,it V 1 a�, i 1\fkk.1-?— ( -S) b q l -,)-s"t,
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
--3 S S -'') I S C
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7 i jF s ';�yLsZt( 7 }C3 r: —1,00L, ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
_fin_-i.,_ -_( 00 ?-- 1 .2-BL ( Z /s) ( /p .! ( 5133 ) 64- eGgc,
YV 014- CONTRACTOR'S REGISTRATION NUMBER copy of card required with each application) EXPIRATION DATE
,.` --1 N 5 0 id 1 E 5 T ( / I Z /i, `r
APPLICANT COMPANY NAME / APPLICANT NAME}'. OFFICE PHONE
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MAILING ADDRESS , ( CITY,STAT IP c
. C t L( CELL PHONE
/ 3 4 G�U,E 5, 1Q3j– -15----77;—'-42..- j (2c) 3 2'( -3 45
RELATIONSHIP TO PROJECT 1 1 FAX NUMBER
0 Architect 0 Tenant Gi Agent 0 Other(Describe) (2-004 6-if -4-2-C•%i
CONTACT NAME PRIMARY PHONE MAIL ADDRESS
-1._---,c-- Cc;,, v) t•- (2C6) 4b4- 4.Z( _ sarN rGt7c 4,24.41.
LENDER ,$ :: " ` je NAME 7.. A
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
r,R�-: .P„ ,, ”i : .P 4 tit.r!. ,. . t...,•.i.'„ 1 4IllDETAILED BUILDING'INFORMATION; �:::'4',;:,:i4., .',1;'.:A::'' , ;1:4:4a_* 1i'',..1,1.:'
rg1 :t
EXISTING USE Z. cam - - c_
� . PROPOSED USE .Sc a A '
1 ��
EXISTING ASSESSED/APPRAIS D VALUE $ C� t�'-( VALUE OF PROPOSED WORK • - ,Orli 1a��.i,.
SPRINKLERED BUILDING? 0 YES p.-NO FIRE SUPPRESSION SYSTEM PROPOSED/REQU` • 1 ■ iJ4O
WATER SERVICE PROVIDER GVLAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER tYLAKEEAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC) 4
• •
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 0 CARPORT 0
NUMBER OF FLOORS =mumPROP096D TOW. • 7-4i;�'
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
..FIXTURES
Indicate number of each type of future to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $ CCS
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(eomm,reial) WOODSTOVES
✓ BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATH ,&3,1T /s ms,
ho) SHOWERS WATER"' CLOSETS irot MISC(Describe)
DIST SINKS DRINKING FOUNTAINS
GAS PIPE OU LETS PS RAINWATER SYST
WASHING M CHINES f. 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 • 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 _ iI ' - _ DATE -4-12..c7404%
nature (Title)
hRELATIONSHIP TO PRO: D T q Owner Dent 0 Contractor 0 Architect 0 Other
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