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08-103453 RECE D © - 03 f �R,.aF �- s3 Federal Way PERMIT coMh1UNITYDEVELOPMENT SERVICES J U L 18 SF MF CO ME EL PL DE E FP 3332 R FEDERALWAY,WA 98063-9718 8 ° PLI CATION ID WAY, / / m 253-835-2607•FAX 25 .09-. um_rtt11<1(irl1eral eh-Y, � OF FEDERAL WAY The following is required infCnl3tS n-an incomplete application will not be accepted. Please print legibly an ink)or type. • PROPERTY INFORMATION SITE ADDRESS_ 31-1-30 I N I I0,-ti'i Ave spoil-,i Federal t Way`W/k q i30O 3 SUITE/UNIT#_ ASSESSOR'S TAX/PARCEL# - _ LOT SIZE(sj) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) 0 SPS aorK-_,N4"-i.1, -I Lt'% Cr() ri0IA VAC i AACk.c (Attach separate page for lengthy legal description) I. PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING ❑ 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) PROJECT NAME(Name of Business or Owner Inst Name) V S1 50...e AtA I-- c 1//k, — • PEOPLE INFORMATION PROPERTY NAME T PRIMARY PHONE OWNER V S PS' By W.- t`-440C%t`-440C%t`-440C%i_ Fit.-4 61-y 7{�� ( ) - MAILING ADDRESSSTATE,ZIP ct`'tom%3 E-MAIL ADDRESS 3 4 30% N-1-+v YC' S ecoil w r<y 1 w� C 0 'T' CTOR COMPANY NAME ,we(' APPLICANT NAME OFFICE PHONE C bev C e&fv c,� n�tpleX (3�,0)(ami g 2.(814 J MAILING ADDRESS CI Y,STATE,ZIP CELL PHONE CV CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER ) i3G-r-v3ULI= ( ) CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS APPLICANTOMPANY NAME APPLICANT NAME O CE PHONE , piex (JY-kel✓t�� ( ( )A 1 -1400 /M�AI�LING ADDRESS A� CITY,STATE,ZIP t ` /`� CELL PHONE tc20 (bT '-'�\ e-- S V00 aZL k-e-/LOi— Cl(b(Cg ( ) - RELATIONSHIP TO PROJECT FAX NUMBER ❑ Architect 0 Tenant b gent 0 Other (2Q )2g.( -(Ebb PROJECTN PRIMARY PHONE E-MAIL ADDRESS .�pte/ CONTACTr-AekLiela._ 1-�k C2-0(0)( (o) 2-et l - 1�(:�aQ� MLACA@ (712(NIe-1d,•t.©r--1 LENDER NAME Per RCW 19.27.095: Lender information is required if project value exceeds$5,000 MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) - ■ DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE 11 'l(� EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ J 1)D V,0 0 SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER o LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) ab PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST SECOND THIRD ADDITIONAL FLOORS(DESCRIBE) • DECK(❑COVERED OR ❑UNCOVERED?) GARAGE ❑ CARPORT ❑ NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SP TOTAL SF "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$ (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) LAYS(Bathroom Sinks) URINALS MISC(Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS(colla) ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE 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 relia, e - - -'t , including its officers and employees, upon the accuracy of the information supplied to the city as a part .4 this appli • '•411 . 1. / 1 ((eke SIGNATURE: �a DATE _ Property a er and/or Authorized Agent o NEW ❑ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO ZONING DESIGNATION CHANGE OF USE? o YES o NO NEW ADDRESS REQUIRED? u YES o NO UP/SEPA/SU? o YES U NO PLATTED LOT? U YES o NO DEMO PERMIT REQUIRED? o YES U NO Bulletin#100—August 16,2007 Page 2 of 4 k\Handouts\Permit Application