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08-105566 • F w RECEIVE k Federal ay PERMIT �� COMMUNlI7UEVELovm�Evrselzv1ccs SF MF BUJ ME EL PL DE EN FP 33325 E'"AVENUE.WA 9•PO BOX 9718 NOV s od p L I C AT I ON "ID FEDERAL WAY.WA 98063-9718 �- / 253-835-2607•FAX 253-835-2609 www.cilyotlederalway.com CITY OF FEDERAL WA`' The following is required inform&l&s-an incomplete application will not be accepted. Please print legibly(in ink)or type. • PROPERTY INFORMATION SITE ADDRESS_ 7O?ill i3 { fhes`/U N3 Of, ')O c.)rt--t SUITE/UNIT # -- ASSESSOR'S TAX/PARCEL # C) b 'Zi I o 1+ - 9 U t e) LOT SIZE (sJ) 1 )9((4.415F LEGAL DESCRIPTION(e.g.Acme Estates. Lot 1) pis...) ''12.���/ t 1.-,)C.-� (Attach separate page 5r Ic,jtl y legal descript o,I MI PROJECT INFORMATION TYPE OF PERMIT *BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION ❑ ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlq) IS•.1=)1=> z� STo P.44.Ca-t^ F--.o o -( -VD c(5'r•t k3C-,' C•Yt't N3A t U M 't-'i4A r 15tom, R'T OF A. L7�4Y C...4.fc',E 'F C.11-t'T'`( / u-r-. c ..-r --- . PROJECT NAME(Name of Business or Owner Last Name) lc7"(5 - C..-‘12-1..-S LL (3 o F FeDL?F-4..L.Wrs�( is PEOPLE INFORMATION PROPERTY NAME PRIMARY PHONE OWNER `(5 l- .s tr=-LCom-.L. •� /or l�^r 1 1•c - Co 0 r..)-r-( (ZOCo) ct - - 2°I1_,(o MAILING ADDRESS CITY.STATE,ZIP E-MAIL ADDRESS CQC) 7 X77 y,/A-TZ'T '- T:t`7v i1'''CC) � TL l\Pc `t8)101 5 t'VAK 1 EAe-e6s mvaPyAcB,ogeir CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE COOS' '14 CO mac.-r cc l LhC V,R,r r,A,dJ F F (A 25) 460'1 - 2'1 o o MAILING ADDRESS CITY,STATE,ZIP CELL PHONE t344Zo 1E FA5-t-&'r>rAV - qtr? ) l vow Wt ctsit: o5 (�z5) 681 - '72`'10 CITY OF FEDERAL.WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER 2.o-C>5- 100 1-3-00- - IZ/31/WO ) (4Z5) 4('1- 7x153 CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS 6Pus - Ct-. 92c '-Gl I©/2.9/ ofO FRAP-IK.STA4 Pr Q.O?ts4ul.eofn APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE stn ARc.14 ir -.c.-r-S "EN)C. 1AEE 5 1-11.1. ►3�S 1---u/J� (<.{Z5 ) 46)1 - 4211 7 MAILING ADDRESS L CITY,STATE,ZIP CELL PHONE tit 7.0 5f EsifACVAre V01 sQ rrE Z50 t.L 5Y0 e- \sIAQ ..7 ( 425) et I - 115e) RELATIONSI IP TO PROJECT ) i FAX NUMBER `Architect ❑ Tenant 0 Agent ❑ Other (-11,5)4(01 - 2i PROJECT NAME PRIMARY PI-NONE E-MAIL ADDRESS CONTACT 1--11W(3 .cJIJ,P (425) 461 - ' 115 14AYn)ES.Lt)41)eOPUS-.4g. M LENDER NAME Per RCW 19.27.095: 1. --IW".j-r- Lender information is required if project value exceeds$5,000 MAILING ADDRESS CITY,STATE,ZIP PHONE ) 20 56 rv-rzpnWWY Sri, z c lu. iWA° 5 (.55) 417 - 2700 • DETAILED BUILDING INFORMATION EXISTING USE C---.'( /( * 17P�Y .E CE'I-1T?--, PROPOSED USE c-.((v( 4_ c --<-C„ .E c14-i-t t EXISTING ASSESSED/APPRAISED VALUE$ 1 1 0�JCp) t QC's VALUE OF PROPOSED WORK $ I�) C CCD SPRINKLERED BUILDING? 0 YES ,(NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES `�NO WATER SERVICE PROVIDER V4 LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL) ' SEWER SERVICE PROVIDER 6d'LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) PROJECT FLOOR AREAS11 1 AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ. FT. SQ. FT. SQ. FT. BASEMENT FIRST 9 &64 SECOND THIRD ADDITIONAL FLOORS(DESCRIBE) DECK(❑ COVERED OR ❑UNCOVERED?) GARAGE ❑ CARPORT ❑ EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSEp SF TOTTALS NUMBER OF FLOORS 1 T 1 1X71 Z4'�' CO **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$ 01 (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION) AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES BBQS FANS GAS WATER HEATERS MISC(Describe) BOILERS FIREPLACE INSERTS HOODS(commercial) COMPRESSORS FURNACES RANGES DUCTS GAS LOG SETS REFRIG.SYSTEMS PLUMBING • BATHTUBS(or Tub/shower combo) LAVS(Bathroom Sinks) URINAIS MISC(Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toilet) ELECTRIC WATER HEATERS SINKS WASHING MACHINES I IOSE BIBBS SUMPS SIGNATURE I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the issuance of this permit does not remove the owner's responsibility for compliance with local,state,or federal laws regulating construction or environmental laws. 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, but only where such claim arises out of the -liance of the city, including its officers and employees, upon the accuracy of the information supplied to the city as a part of this ap.tic, on. SIGNATURE: A... DATE $ A v"J Z KFC/ Property Owner and/or Authorized Agent FOR OFFICE USE ONLY ❑NEW n ADDITION n ALTERATION n REPAIR n TENANT IMPROVEMENT BUILDING SHELL ONLY? n YES n NO BASIC PLAN? n YES n NO ZONING DESIGNATION CHANGE OF USE? n YES n NO NEW ADDRESS REQUIRED? n YES n NO UP/SEPA/SU? n YES n NO PLATTED LOT? n YES n NO DEMO PERMIT REQUIRED? n YES ❑NO Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application