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06-101765 RECEIVED COMMUM7Y DEVELOPMENT SERVICES �y 33530 FIRST WAY SOUTH•PO BOX 9718 CITY OF � FEDERAL WAY,WA 98063-9718 Federal Way7 dtR.MIT APPLICATIOI \ 253-6614115•FAX:253-6614129 APR U O Huta_'— Jrderal o=.mm ti • . WAY _ _ To: __......7r-Ab For OLric<Ux Only C '_(�,�• — - — _ • The ollowin. is re.uired in ormation-an income fete a..lication will not be acce.ted. Please .rint le.ibl (in i, or •,,- ■ `PROPERTY INFORMATION . SITE ADDRESS: g%27,3 32' ' .QC" S) SUITE/APT# ASSESSOR'S TAX/PARCEL#: - SQUARE FOOTAGE OF LOT: /� LEGAL DESCRIPTION(e.g.:Acme Estates,Lot 1) �eXE2fI'> - 61`Z- /JE 'rid 7G ,1 4 A 1, 6-45r ei00/' .46 (Attach separate page for lengthy legal description) C0•eif P#1,6 .- 1 PROJECT INFORMATION . TYPE OF PERMIT(This application): 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION o ELECTRICAL 0 ENGINEERINGFIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu): E13LbESS/ /5iE4 PROJECT NAME(Name of Business/Owner Last Name): / " / d 44-L./5e- A i© - 2 t i ■ PEOPLE INFORMATION PROPERTY NAME: / �.J PRIMARY PHONE: OWNER lJ E" C�i/4 E i, ( ) MAILING ADD SS(STREET ADDRESS;): CITY,STATE,ZIP •CONTRACTOR NAME /5-158 COMPANY OFFICE PHONE: ,:-14 , iG — tei - (( .) :-) fi'v ( 429C MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP CELL PHONE: 2-70.? ?6-61 4,,e. C -Lace idAia f7(3 ,iZ4 ( ) CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: EXPIRATION DATE: FAX NUMBER: L L-_9 I — i 0 1 9 fl b- da 42/ 3/ / o/ ( ,) ) f2 - G1 `= C` ate CONTRACTORS REGISTRATION NUMBER: ../ D • EXPIRATION DATE: ( (copy of card required with each application)06 4 'S / F 7 0 9 2 c F _ /D / 06- /g7C. LENDER NAME: DAYTIME PHONE: (If Proposed vnur>$5,000) ( ) - MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP APPLICANT: NAME: COMPANY OFFICE PHONE: d -tliE A5 & JiiQ 4e-TD2 ( ) - MAILING ADDRESS(STREET ADDRESS): CITY,STATE,ZIP EVENING PHONE: ( ) - RELATIONSHIP TO PROJECT: FAX NUMBER: ❑ Architect 0 Tenant ❑ Other(Describe): ( ) - CONTACT PERSON FOR THIS PROJECT: ❑ Property Owner Contractor ❑ Applicant E-MAIL ADDRESS: ■ DETAILED BUILDING INFORMATION • EXISTING USE: a 7 PROPOSED USE: f C 74/ e ,%(C t- EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $ SOO SPRINKLERED BUILDING? ,,> YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: /2 YES 0 NO WATER SERVICE PROVIDER p`bAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC) - ■ PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING SQ. FT. PRO• D SQ. FT. TOTAL BASEMENT FIRST SECOND '201boo 7.iC426 24-426 411, THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE/CARPORT HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING D PROPOSED 2 143/ 424 **NEW HOMES ONLY** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ —1` ■ FIXTURES Indicate number of each type of fixture that is 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(Commercial( WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) _COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS(orTub/Shown Combo) SHOWERS WATER CLOSETS(rode) MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS • GAS PIPE OUTLETS SUMPS RAINWATER SYS WASHING MACHINES URINALS HOSE BIBBS LAVS(Bathroom Siok 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 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(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, including its officers and employees, upon the accuracy of the information supplied to the city as a part of this application. NAME/TITLE: ,� �& DATE: ��( G/ 7 /44ature) (Title) / RELATIONSHIP TO PROJECT: ❑ Property Owner ❑ Applicant Contractor ❑ Architect ❑ FOR OFFICE USE ONLY: o NEW a ADDITION ❑ALTERATION o REPAIR a TENANT IMPROVEMENT BUILDING SHELL ONLY? ❑'YES a NO BASIC PLAN? o YES o NO ZONING DESIGNATION: CHANGE OF USE? o YES o NO NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? ❑YES o NO PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? a YES o NO I• 1411-P1.'1 #i i1:% . ,'`} Page 2