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10-101416 ........a.. r\11i{u, vire et tieSIC . Approved s Detailed to attached details "111 - / / 4:-.) ;atRrIvE1bJect 131% ederai Way +E-Rj,commuNITY DEVELOPMENT SERVIC s _ SF MF CO ME EL PL DE E 4 FP 33325 8Th AVENUE SOUTH•PO BQ 1 FEDERAL WAY,WA 98063-97 8 �� 2a LI c ��N 253-835-2607•FAX 253-835-2609 Ir / www,cttuofffe7ederalwau.com C RAL l¢''44 The follaiv is requ -• i` rmmation-an incomplete application will not be accepted. Please print legibly(in ink)or type. / q III PROPERTY INFORMATION2 SITE ADDRESS_ 3 J e/eo Aue C' /E ' l�0U. -t SUITE/UNIT# A Op ASSESSOR'S TAX/PARCEL# 9 A (� C�y / - (f� 6 (.='� LOT SIZE(sf) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal description) • PROJECT INFORMATION TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING gl- IRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) AYAi1C ttvii,,.-f /7ftitSio" ,'o ,*/ l i ural,- E01710: FRF 5,Od(w/1frr5 e124, / L _ PROJECT NAME(Name of Business or Owner Last Name) GI5 G� ,� - A ( t..C_ .'tj • PEOPLE INFORMATION PROPERTY NAME `,i- t/&J PRIMARY PHONE OWNER ' `J' }..I1.i ( ) MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS CONTRACTOR COMPANY NAME APPLICANT NAME '� OFFICE PHONE `j� No27k1wL.F5f 2.e� 5 y5�f 5 L' /© 4 T/// 06 ) 77Z- -756e VV MAILING ADDRESS CITY,STATE,ZIP CELL PHONE /1 53/5 S. /765 . ' res 7vKw.'�, 9�i6�' (z- & 373 3 s4 CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER (Z( ) 77z -750`1/ CONTRACTOR'S REGTNUMBER Sq/p))REXPIRA,fIONOE-MAIL ADDRESS r41FS9 CleJilitelow6[c5 Sie ws .COM APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE . 41W, ' /35 A 4,,VC— ( ) MAILING ADDRESS CITY,STATE,ZIP CELL PHONE ( ) RELATIONSHIP TO PROJECT ,,// FAX NUMBER 0 Architect 0 Tenant ❑Agent ❑ Other 5uK Ah re nrk, ra- ( ) PROJECTNAME 11 PRIMARY PHONE E-MAIL ADDRESS CONTACT CG / / - (zo4 ) 373 - 13a'G i4w46-_ v15 /41.6-- LENDER 4fnv� LENDER NAME Per RCW 19.27.095: Lender information is required if project value exceeds$5,000 MAILING ADDRESS CITY,STATE,ZIP PHONE • DETAILED BUILDING INFORMATION EXISTING USE OCA PROPOSED USE Dcf/eC 7 / 06 EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ It/l 'o 7 SPRINKLERED BUILDING? trYES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES ❑ NO WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE o TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN o HIGHLINE ❑ PRIVATE(SEPTIC) • • 411) • PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEME FIRST SECOND THIRD ADDITIONAL FLOORS(DESCRIBE) DECK(❑COVERED OR ❑UNCOVERED?) GARAGE ❑ CARPORT ❑ EXISTING PROPOSED TOTAL •AL EXISTING SF TOTAL PROPOSED SF TOTAL SF NUMBER OF FLOORS **NEW HOMES ONLY** NUMBER OF BEDROOMS !.TIMATED SELLING PRICE $ 'r IXTURES Indicate number of each type of fixture to be instal-: or relocated as part of this +roject. Do not include existing fixtures to remain. MECHANICAL Value of Mechanical Work$ (A °OPY OF BID OR ESTIMATE MUST BE INCL.'I ED WITH APPLICATION) AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLIs1 WOODSTOVES BBQS FANS GAS WATER HEATER' MISC(Describe) BOILERS FIREPLACE INSERTS HOODS(commercial) COMPRESSORS FURNACES RANGES DUCTS GAS LOG SETS REFRIG.SYSTEMS PLUMBING BATHTUBS(orTLb/Showe- ombo) LAVS(Bathroom Sinks) URINALS MI (Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toilet) 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 ay • made by any person, including the undersigned, and filed against the city, but only where such claim arises out of the reliance of e c' ! ncluding its officers and employees, upon the accuracy of the information supplied to the city as a part of this ap • 'on., , SIGNATURE: _ �� /i DATE T_ ' operty Owner and/or Authorized Agent FOR OFFICE USE ONLY ❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR n TENANT IMPROVEMENT BUILDING SHELL ONLY? YES ❑NO BASIC PLAN? ❑YES NO ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO NEW ADDRESS REQUIRED? o YES E NO UP/SEPA/SU? o YES o NO PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? ❑YES ❑NO Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application