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08-104166 . .1%. a RE EIVEI CITY OFg i 0 (-it' W '�/ "" SEP �04 2008 ( - Federal � COMMUNITY DEVELOPMENT RVlCES- OF FEDERR IIT SF MF CO ME EL PL DE EN P 33315 8. FEDERAL UE SO(IfF!•PO BOX 97 18 C )PLICATION �° FEDERAL WAY,kr 96ni corn 18 / 253.635.2607•FAX 253.835-2609 wmu_.ciluollerteralwau.mm The foilourin. is re.uired i ormation-an incorn•lete a..lication will not be acce.ted. Please .rint lee ibly(in ink)or ty.e i N I�PROPERTY INFORMATION 1,^ SITE ADDRESS iyo N S• 32oth Feb L(,� /A yl W 99/0o33 SUITE/UNIT# ASSESSOR'S TAX/PARCEL# D t ` / D 'L 94- g_ 2 ©J cLOT SIZE(sM 361,0 CO, LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach.eparate page for lengthy legal description) ■ PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERINIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu) �!���YY IIeSTAil 4 tl)NEW Fite. ALARt'Y1St�ST/l.tY1 . PROJECT NAME(Name of Business or Owner Last Name) /O 1c ye) g,&A{L /4ouS& $ PEOPLE INFORMATION PROPERTY NAME PRIMARY PHONE OWNER Oa NC l-I yolk-) th tin 7owJ&SooA.) gob )29r -&.54/3 MAILING ADDRESS CITY,STATE,ZIP l your S,gieth sT. CvyiaA_wAy, 14/4 98003 CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE rl ea 0/0E,pv L. i7AUE PetkiTANAt2 (Zo6,)5'7s -.co 3 61 MAILING ADDRESS CITY,STATE.ZIP CELL PHONE /a7 w-S414)47'0,/05wD. Auto A w.4 99cai ( ) CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER _2 I (Z'3i /28 (2.53) 93‘--y97c CON'TRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE FzRe0 .7 *- o9 Kw 6- //4 /49 APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE Ft 2rz oN1, /4Jc. 1)141)€_ c)r�20 )412- (Zo6)5-9s-O51/ _ MAILING ADDRESS COY.STATE,ZIP CELL PHONE 10'7 WAS t4,AJ 7oti) 5LUD. Ai.4O,04 (/t W A,98003 ( ) - RELATiONSHIP TO PROJECT FAX NUMBER 0 Architect 0 Tenant 0 Agent 7-Other(Describe)(Q-/t/T4 4CTC 1 (ZG3)9,35 -(1974 CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS Dr4U- PokiTJ 412. ea6)69S' -©3l1 LENDER : V` °y:` r , ym ; NAME ,- MAILING ADDRESS CITY.STATE.ZIP a DETAILED BUILDING INFORMATION EXISTING USE S/ ri4)2 /114GtS/L PROPOSED USE -5-/—/EAI2 140 14 5E./� EXISTING ASSESSED/APPRAISED VALUE $ / Z%' zoo.......- VALUE OF PROPOSED WORK $ (�i Qo6 ---- SPRINKLERED BUILDING? X YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES )'NO WATER SERVICE PROVIDER 0 LAKEHAVEN O HIGHLINE TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER a LAKEHAVEN R.HIGHLINE 0 PRIVATE(SEPTIC) 1 4 I PROJECT FLOOR AREAS ,. AREA DESCRIPTION EXISTING PROPOSED TOTAL sg.FT. SQ.FT. SQ.FT. BASEMENT /d6 n, FIRST /aa - 9, 2`o , SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE 0 CARPORT 0 EXISTING PROPOSEDw tSTR1:7 SY ^ /O s*` NUMBER OF FLOORS " /] �� h sie s 9 i "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,rom0 WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS or Tub/Shove.Combo) SHOWERS WATER CLOSETS(Tonoq MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS(Bathroom Sink.) 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 farther,that I am authorized by the owner of the above premises to perform the work for which the permit application is made. It further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses, and attorneys'fees incurred ini 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. R NAME/TITLE //4 ) ,-- Q DES/CC/00Z_ DATE / -�c (Signa ire) (Title) v RELATIONSHIP TO PROJECT ❑ wner 0 Agent Contractor 0 Architect 0 Other ' B E .r i 1 r 4 3 717247 .fix 527 ,ta,.s .-I' '°x� ".`k ®a410' 8'a S' # s D to i ® �Rks, k' t ® .; aPI�Ax Dr' ie3 ffi. wi;� °' Ksa ,° ;- E • x ® .aa°hip'' 4 Bulletin#100-January 7,2005 Page 2 of 4 k\Handouts\Permit Application II