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05-101191 I CITY of ECFV 6Chi - ± 0i / q Federal Way PERMIT COMMUNTIYDEVELOPMENT SI 1 2005SF MF CO ME EL PL DEE /�P 33325 AVENUE SOUTH Pow 8 APPLICATION TD FEDERAL WAY,,WA WA 98063-9718 253-835wcitt-260ro((e7•FAXderal 2 nut- FEDERAL 1fV / / Silt) ww BUILDING DEPT, The ollowin. is re,uired in ormation-an Inco .fete a..lication will not be acce.ted. Please .rint le.ibl (in in or .•. R PROPERTY INFORMATION SITE ADDRESS 3 57 040 1 tr P4./9C.0 S SUITE/UNIT# ASSESSOR'S TAX/PARCEL# q 2 to S-- 0 i - O O 3 O LOT SIZE(sf) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal desr pt.on) ■ PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING V FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) �JJSTA•ll Qi1E 0c'u.) WC-7 SYSTEM F01C x!5Tf,t!(7 &)tLDia!G. ; .:C joc,T4C..L. (1/43c‘..4-) vl roE4R-Loa0L)$.3O 'Ccs Mk—• ,4,) we - s icrEnn PROJECT NAME(Name of Business or Owner Last Name) K O v ArL%,, e v i C...1)1>s t, PEOPLE INFORMATION PROPERTY NAME . PRIMARY PHONE OWNER C34A-t.11(-.1 ( ) - MAILING ADDRESS CITY,STATE,ZIP CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE c%QC- SPR.%gic..,.&.ts 3-4.)4. 44 gfliZA. a3 (2s-3) 8u. - oo MAILING ADDRESS .CITY,STATE,ZIP CELL PHONE 4uc d ON 1ST- E. Sutnoex- w,4 q$3/O (Zc3- ) ?7' - '�{a3' CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER 6 S- ( n-Q fa 3 -3 9 Ct-B L / / ( ) CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE c 1 e_ f., s 1 , 'R e. S 1Z/ /04. APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE MAILING ;,. . S C 061tYlijoK CITY,STATE,ZIP - CELL PHONE ( ) RELATIONSHIP TO PROJECT FAX NUMBER 0 Architect ❑Tenant 0 Agent ❑ Other(Describe) ( ) - CONTACT NAME © PRIMARY PHONE E-MAIL ADDRESS %tt-C FJ1 ft.QS11.'") ( ) - K`141( Fc I e(aA.c -Sr;ACr- LENDER erR 9 ^09Zein ormatio Is `i NAME wired pro, value exceeds"$5 000 A .,tea �s�-A,.�: . ._ aa:a:,�a„��;'�?.�. ` MAILING ADDRESS CITY,STATE,ZIP a DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ Vie 3c)el SPRINKLERED BUILDING? ❑YES p (O FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? irES a NO WATER SERVICE PROVIDER JAABEHAVEN ❑ HIGHLINE O TACOMA a PRIVATE(WELL) SEWER SERVICE PROVIDER a LAKEHAVEN a HIGHIdNE 0 PRIVATE(SEPTIC) r 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❑ EXISTING PROPOSED TOTAL TOTAL E7QSTDYO SF TOTAL PROPOSED SF "TOTAL SF NUMBER OF FLOORS **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(comm r<»1) WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS t PLUMBING t BATHTUBS(or Tub/Show,Combo) SHOWERS WATER CLOSETS(foleq MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS(Bauuoom s nks! 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,' tha• t I am authorized by the owner of the above premises to perform the work for which the permit application is made. I further agree o hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred to the investigation and defense of such claim),which may tie 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. A NAME/TITLE 74_6., 't' DATE 3/f � (Signature) (Title) { RELATIONSHIP TO OJECT ❑ Owner ❑ Agent Contractor ❑ Architect ❑ Other 1 �� ai DITION� _ ALTERATION , 'ti=REPAIR : TEMANT II4IPR0 MENT:' f-, , DIN„ „SHELL , . 'A YES NO ; ,BASIC PLAN?4 „ -o YES NO ' 'moo' ;I a ESIGNA ION'S-��' :DEM GE OF USEa ry � R to YES NO �; - YFS,, EWrDRE32EQUI12ED? � : NO., UP/SEPAJSU?, ( xc� CES� tti0 . D •YES NNO ,-DEMO HERMIT2FUIRED ,. > ° �� Bulletin#100—January 7,2005 Page 2 of 4 k\I IandoutsTermit Application