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07-102083 '', RECO" / 0 7 - 7 / R V O 2un of*., Federal Way APR 1 8 2007 PERMIT COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE EN FP 33325 8TM AVENUE SOUTH•PO BOX f'�/O LI CATI O N FEDERAL WAY,WA 98063-9711'r ' V���(�� . l 253-835-2607•FAX 253-835-2609 BUILDING / www.ciluoifederahucw.corn /// The ollowin• is re•wired ' ormation-an incom•lete a••lication will not be acce•to . Please •tint le!ibl (in ink)or - •e. ^-�■ PROPERTY INFORMATION SITE ADDRESS 331'104 9 4 a� CU c S r /C) SUITE/UNIT# Z�1'2 ' ASSESSOR'S TAX/PARCEL# 9 'L cff vo ``) 0 I - (1 S.Q(bgi LOT SIZE(sf1 Si [� [) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) o Ck.Q wL_vii CSL. J. C,-..-e,,s V -Cy. ,,, , 4 OZ (Attach separate page for lengthy legal description) ) ■ PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION tilELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) kdol‘\l'rub :Q.-,C(51,:wc1Y4 X1—ryw► 'S SK'nni► a,. `nenrr. / }-i oLe-.$ , ► S+'tioce , 1 1 a 1-- 1 ( 51�reob I % - I - ` PROJECT NAME(Name of Business or Owner Last Name) G'?1 ch,,,�&01nD - • PEOPLE INFORMATION PROPERTY NAME j f PRIMARY PHONE 2 OWNER Gr) CIpJI/1, Skev&Q_ L-- L c (253) -135 -3c1 MAILING ADDRESS CY.STATE,ZIP 3 4 oo o /tc-S Fede vel uJ %wA ° `600.3 CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE vJ S‘,.;r,�i�I� Act vkA-14n.C. K2 4f va_A Q 3) (24(,) 32Z -32. MAILING ADDRESS CITY.STATE,ZIP CELL PHONE t2-' 3 S. )acAL-50, SV Sea,K2. I OF FEDERAL WAY BUSINESS LICENSE NUMBER " EXPIRATION DATE FAX NUMBER 20 O0 ! Q. L 12 L9 00BL Iz / 31 /©-7 (2ci- ) 5ZZ - 7Z(q NTRAC 'S REGIS7RA l�BER(co o r qui with each application) EXPIRATION DATE 15 . LI1:4: 1 2 _ 12/ C)7 / 0 7 !J APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE S'ZYNA,SZ- a5 a 66Ni-e_ ( ) - MAILING ADDRESS CITY,STATE,ZIP CELL PHONE ( ) RELATIONSHIP TO PROJECT FAX NUMBER ❑Architect 0 Tenant a Agent a Other(Describe) ( ) - CONTACT NAMEPRIMARY PHONE E-MAIL ADDRESS v U`C.e.V � %-OO V•410 5o v\ ( ?EAS ) 3z 9- 320,0 ,I , Dr0a11ce,..51,-,6,-,›Lr ...,.Ca-, LENDER " 0.47 ' NAME ® e MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) • DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ ( S 2-(a . c2-- 1 2--1 SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE a TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER a LAKEHAVEN ❑ HIGHLINE a PRIVATE(SEPTIC) 110 • PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING POSE SQ.FT. PROSg.FT.D Sg.FTTOTAL. BASEMENT FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE 0 CARPORT 0 NUMBER OF FLOORS EXISTING PROPOB= **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 I Work $ GAS LOGS Value of Mechanica AIR HANDLING UNITS EVAPORATIVE COOLERS REFRIG.SYSTEMS BBQS FANS HOODS(commercial) WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS Owlet) 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 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 am authorised 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 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 ci is officers and employees,upon the accuracy of the information supplied to the city as a part of this application. NAME/TITLE DATE / i�O Ito (Stgnature) Crine) RELATIONSHIP TO PROJECT ❑ Owner ❑Agent contractor 0 Architect 0 Other VOtt ifi 41. �• e6 - *IVP'77.16iita 61;1:411. s a e* ,4WW a 4E 4 •' ?�11."1,,';r74-.14(® , 4r� 6 a ia t ®r i �,. rj Bulletin#100-January 1,2006 Page 2 of 4 k\Handouts\Permit Application