08-101250 0 ( g-- ----C
LL _1Federal Way MAR 14 2008 PERMIT
COMMUNITY DEVELOPMEM'SERV/CSS SF MF CO �IOfE)EL PL DE EN FP
9332FED AVENUE FEDERAL
OU' aB�9(5 F FERE PtMYI C ATI O N
FEDERAL WAY,FAX
9 8 T� /
253-835-2607•PAX 253.835.2609
www.dluoflederalwau.com CDS
The ollowing is re•uired in ormation-an Inco •lete a••lication will not be acre•ted. Please •rint legibly n in or ty•e.
/ ,i ■ PROPERTY INFORMATION
SITE ADDRESS t ? 6 5/1 /e h 4 E .X,i SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# / a. q 6) - _L a LOT SIZE(sl
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING )(MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
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ecAS
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PROJECT NAME(Name of Business or Owner Last Name)
M PEOPLE INFORMATION
PROPERTYNAME - ,
PRIMARY PHONE
OWNER ( li l 4- C3 -> LAC" ) 444 -S
MAILING ADDRESS CITY,STATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
kl0r414`l, `, s ite v'14:-C: (2w) 41 •. S7
MAILINGpADDRESS CITY,STATE,ZIP CELL PHONE
PD D gtiK %L-t7 r4-1E -)a• 6 ( )
CITY OF FEDERAL WAY BUSINESS� LICENSE NUMBER ` EXPIRATION DATE FAX NUMBER
-t 1-1 t1 3 2. 1 -B L ' 47- /5/ / c (2.0 4") - '3i
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATIONDATE
hi ° a 11 S q. (62 3 g 4
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APPLICANT COMPANY NAME APPLICANT NAME ^
Y�`W� bckv\j (,,, �- T C( (z ) -'-t 265-X
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
e Rd l66 (206 ) uZZ - X 42
RELATIONSHIP TO PROJECT //��� FAX NUMBER
0 Architect ❑:Tenant 0 Agent Other(Describe)Oitkrteat.Cs -aPL ( ) -
CONTACT NAME • PRIMARY PHONE E-MAIL ADDRESS
ei2 -6.V. 1> .) (Lc ) 41 -..R .:,--1
LENDER
MAILING ADDRESS CITY,STATE,ZIP PHONE
•
( ) -
■ 'DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ '
SPRINKLERED BUILDING? ❑YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES ❑ NO
WATER SERVICE PROVIDER a LAKEHAVEN a HIGHLINE a TACOMA a PRIVATE(WELL)
SI:Wi:R SERVICE PROVIDER a LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
•
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 ❑ CARPORT 0
NUMBER OF FLOORS e�eararp reorosso rarer _._> �t ra x,
**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 notinclude existing fixtures to remd
in.
MECHADIICALCqq =.4DValue 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 A_ GAS PIPE OUTLETS
PLUMBING •
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS crow) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom sum) 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 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 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. �.
NA /TITLE t` ,40�/ '
ME DATE 3AN/08
(Signature) Cade)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent )(Contractor O Architect t7 Other •
,off r� en f� \-� 1£'., a.�e, 3.0 7; 7or,x'�', ,7 ,4: >n,1.
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