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07-100234 VWPr VIP .� -7 - L 2 3 Federal Way PERMIT — — coMMUM7YDEVELOPMENT SERK(CEs�AN 1 6 ' k 7 SF MF CO ME EL PL DE EN FP 933258 H ERALWUE AY.WA 806390X971 'LI CATI O N FEDERAL WAY.WA 98063-971 B , 253 835 2607•FAX 253 835-a�-(Y OF FADS www.cYtuollederalway.mm BUILDING DE , The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type. • PROPERTY INFORMATION a_-_ BITE AD : �-� _�► (�j 1 � 8UITE/UNIT# —00 ASSES OR'S TAX/PARCEL# / Q` ' 5 0 b - Q C) d 0 LOT SIZE(s,)) LEG DESCRIPTION(e.g.Acme Estates,Lot 1) In PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING i 1LUMBING dECHANI 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit oniti) t b-E 'r' t. 61AS c Js - c2 tL... t•IEt 1& CIA rkj t PROJECT NAME(Name of Business or Owner Last Name) ��..%0.,N.) rj 1„ j .I2LT- • PEOPLE INFORMATION PROPERTY (I\ ^7 ` /,, C�_�- OWNER I ( 40� �I. (te ds- /J ((/`Jc MAILING ADD Cg�.�r ATE.ZIP E-MAIL ADDRESS l(Q 11 cr true.. — U rfri .vaca!1)-0 _ CONTRACTOR OFFICE PHONE C�( rIPANY APPLICANT N^� 1 i1+�- � ' S�1�) `tN�j Tom. ( at (�425SZ-13© LI N f. 9 4 Q��� CITY.STA .ZIP CELL PHONE l r i-AAELL L \ O ()SI (LZ-5)?1( - 2.5'22. C FEDERAL Y BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER ( ) - COPY of card required r�� CONpT-R�ACTOR'S REGIS ON NUMBER (�{�, EXPIRATION� DATE E-MAIL ADDRESS }., with each application --✓ RV 5 0 �T,. O S S q,, 1 Ao/C'' ,Q 1.ke. .1 V�sC3(ce r(.cm APPLICANT CO ANY NAME APPLICANT NAME OFFICE PHONE ( ) - MAILING ADDRESS CITY.STATE.ZIP CE PHONE RELATIONSHIP TO PROJECT /Q NUMBER ❑Architect o Tenant o Agent ❑ Other l ( ) - PROJECT E CONTACT PRIMARY PHO I E-MAIL ADDRESS ®IJ N ND Q.6o 0J b 6 clic)PteeG cSTh&J'i"t P ' 1 fe-<_ LENDER NAME Per RCW 19.27.095: Cc' rider information is required(f project value exceeds$5,000 MAILING ADDRESS -.01111111111 CITY.STATE.ZIP PHONE ( ) II DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 91 0 U SPRINKLERED BUILDING? ❑YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES 0 NO WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) • PROJECT FLOOR AREAS # �_- AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST SECOND THIRD ADDITIONAL FLOORS(DESCRIBE) DECK(0 COVERED OR 0 UNCOVERED?) GARAGE 0 CARPORT 0 - + . PROPOSED TOTAL TOTLISIIama SP '�-_ TOTAL PROPOSED sr TOTAL SF NUMBER OF FLOORS "NEW HOMES ONLY NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ Indicate number of each typo. /fixture to be installed or relocated as part of this prof Do not include existing fixtures to remain. MECHANICAL Value of Mechanical Work S OF BID OR ESTIMATE BE INCLUDED WITH APPLICATION) 2.. AIR HANDLING UNITS EVAPORA'11 COOLERS GAS PIPE OUTLETS WOODSTOVFS BBQS FANS `, I GAS WATER HEATERS MISC(Describe) BOILERS FIREPLACE INSERT, HOODS(Commenla)) COMPRESSORS FURNACES .F RANGES DUCTS GAS LOG SpTS/ REFRIG.SYSTEMS PLUMBING BATHTUBS-(or Tub/Shower Combo) LAVS(Bathroom SEISM URINALS MISC(Describe) I DISHWASHERS RAINWATER SYST , ;CUUM BREAKERS ,•-• -�S DRINKING FOUNTAINS SHOWERS WA •' CLO ((bile) ELECTRIC WATE EATERS I'L SINKS I WASHIN • CHINES HOSE BIBBS SUMPS SIGNATURE I cert(fy under penalty of perjury that the information furnished by ate is true and correct to the best of my knowledge,and further,that I am authorized 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 ncluding costs,expenses,and attorneys'fees incurred in the investigation and defense of such claim),which m made by any pe n, tiding the undersigned,and filed against the City of Federal Way,but only where such claim arises out of the rel of the city,i 1 i dicers and employees,upon the accuracy of the information supplied to the city as a part of this application. / NAME/TITLE -P{ice.l eCX ( 1(�tle)ilv F\4171DATE '/ f"2-1() 3 )gnat RELATIONSHIP TO CT 0 Owner o Agent ❑ Contractor ❑Architect 0 Other a NEW a ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT BUILDING SHELL ONLY? a YES o NO BASIC PLAN? a YES a NO ZONING DESIGNATION CHANGE OF USE? a YES a NO NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES ❑NO PLATTED LOT? o YES a NO DEMO PERMIT REQUIRED? o YES a NO Bulletin#100-January 1,2007 Page 2 of 4 k\Handouts\Permit Application