Loading...
06-102043 n 41/4 Y OF - CI _ �111, � 2c) - C� Z fj� 0 64 Federal WaCIV j R COMMUNITY DEVELOPMENT SERVICES t} PEMIT sF FCO ME EL PL DE EN FP 3332FEDERALWAYSWA 980 -8970189718 2, 5 "R 253-835-2607•PAR 253-835-2609 A P P L I CATION TD e..-- / L ry 1 / wtuw,citvoffedemhontt.aim IF FEDErBALWA't d ( ( : The following is reuined'l llf pTeion-an incomplete application will not be accepted. Please print legibly in ink)or type. `' ■ .PROPERTY INFORMATION SITE ADDRESS ,J I avn ,3677--- j 2 f)' G) SUITE/UNIT# ASSESSOR'S TAX/PARCEL# ' 1 a / ' - t C ' LOT SIZE(sf LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) 1 (z/ ? 771/',!t ,/ - fi F�;4; 1)' { (Attach separate page for lengthy legal description) t J J • • PROJECT INFORMATION. TYPE OF PERMIT ,BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) d a 4 - be- c iz-rpt x-1°6 45, 4 '4 ,L, 6z/-495,40/) ,� r� / PROJECT NAME(Name of Business or Owner Last Name) 51,14\ ii d(11 0 la 47 • PEOPLE INFORMATION PROPERTY NAME PRIMARY PHONE OWNER :ceik(,�" SIM �e �L/�� ( ) - MAILING ADDRESS/T CITY,STATE,ZIP CONTRACTOR COMPANY NAM��j`/'� � APPLICANT AAME L,w�/j �^ OFFICE PHONE �^ MAILIN DRESS / ii)/ ' ' ST 6]P z „' //�Di!,-, 7� /-// 9'3 7 �_ CELL PHONE f /e-� -' Al /I� r/j" ,. i/ / - Zs of CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER XPE I� E FAX N MBER — — -B L / / ` `3X`7TIZ j`� C��O11NTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE ,L7G ) c f- 1. - - - .l '9t- larV APPLICANT COMPA NAME APPLICANT NAME OFFICE PHONE . Ark,' i (N , ;. �,//,J IA'il c. ' i{Z - 97339' MAILI ADDR 1 .---- CITY STATE,ZIPi CELL PHONE RELATIONSHIP TO PROJECT / �I `�j - ✓iJ FAX MBER ❑ Architect ❑ Tenant ❑Agent 0 Other(Describe) (.-94:13716-1- 9 71j , CONTACT PRIMARY PHONE E-MAIL ADDRESS 0 lee 4 LENDER , - r,z , w,y NA t: �� MAILINGADDRESS CITY,STATE,ZIP PHONE r T , ,tr ';::' <x. .i -;u „, :• DETAILED BUILDING INFORMATION ,, '• - - EXISTING USE `' l PROPOSED USE 4.7.F. t-' EXISTING ASSESSED/APPRAISED VALUE $ � OVZ) 1 VALUE OF PROPOSED WORK $ 3e/tee SPRINKLERED BUILDING? 0 YES 4U NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 00 WATER SERVICE PROVIDER ©LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER ci LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) t V . i PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST SECOND ONDa/1C-9-fl- ) THIRD ------------------ - FOURTH ADDITIONAL;FLOORS(DESCRIBE) " ECK(COVERED?) / .0 9 —D QE 0 CARPORT 0 LMS7MSO PROPOSE TOTAL ,4),'i¢" ,,ask`' NUMBER OF FLOORS "NEW HOMES ONLY* NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ 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(commercisi) WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS xlµp PLUMBING -.. -------- BATHTUBS(orrub/showorcombo) — SHOWERS WATER CLOSETS trona) MISC(Describe) DISHWASHERS _ SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS(Bathroom sinks) _ VACUUM BREAKERS ELECTRIC WATER HEATERS ( `DISCLAIMER/SIGNATURE BLOCK - • 't 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 4am authorized by the owner of the above premises to perform the work for which the permit application is made. I further agree to hold I 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,includi s officers and emplo 's,upon the accuracy of the information supplied to the city as a part of j this application. / --'---/ �j� f '//ii v' di7/1A. � DATE 6-7:°‘:::::7 r � � .< r /� �/ / NAME/TITLE (Signature (Title) RELATIONSHIP TO PROJECT CI Owner 0 Agent o Contractor 0 Architect ❑ Other k 4 5 s 7�S x +v a ivE14.� r LL r `� m � � ,-;;;Amp,` a a,FT.:At D @.� .? s s-,4;p ®l , :"'. i R�^r� o E „i ,, u ,,r.- ,a-- ®® ='";r �.- "4"-�`"�`a -�»sY:0;4 j , ti ;�r.0�s i`•� �' C� �: r�aa � `� 'i..,� t n 2 .,SR '® „ A v ..'(r� a [ scpN 4¢ �,L �,"`�.,`:�..:`G'r3A�� r7��i :a �i�, Pwta i ��� �. bv�t� .,�s«u�.m �,n f ,�,� ,,•5� itta a mak°: ��r�qFr .t k- r r.r+ "'7"'r� �P ,y`C` k. ,2' `` A t't &1 3;s9 1 s N 6 C 1�,x yri.rG4y3�Y o f xnl B ? L a1 � ' A ® & p' 1„6, D . xq -nl t a0 ,.,usrwP ® ® : x 'l5zsev I ' ' z �e k r6t.uA a. i -- outs�Pemut Application Bulletin#100—January 1,2006 Page 2 of 4 k\Hand