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08-104304 V • le' stn of ` '� l o 4,3 O FederalWay� ' I PERMIT — — SF MF CO ME EL PL DE EN,COMMUNITY DEVELOPMENT SERVICES FP 3332FEDERAAVENUE SOUTH 980 397X9718 APPLICATION To / / FEDERAL WAY,WA 98063-9718 253-835-2607•FAX 253-835-2609 wtvw.citt !atl.carn /� �//� The oliowt, its re uireec o n to thi-d4 thlom,lete a•'lication will not be acce•ted. Please .rint le•ibl (in ink)or . I PROPERTY ROPPERTY INFORMATION SITE ADDRESS .',7-5 4- Q5 1 ' �x• ✓0'w`r^ SUITE/UNIT# ASSESSOR'S TAX/PARCEL# P. f' D O 0 - 06 -4- 0 LOT SIZE(sf) t c_cv. i -, 'C l otz) 7 '' B LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) -�- Attach separate page for lengthy legal desenptlonl • PROJECT INFORMATION TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING El FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit(anly) t.)re A tarry, Te v L ni ya/�vv��w = Race 3 So vas{- -XS ( 0 INC- }ewe Cun , adc- (Lp nth&etch*oyv &A/((pA 1 a-rld.. re-p( - 4S ,n ai-i Fic a ti trn CIS--LI i CA-A. • PROJECT NAME(Name of Business or Owner Last Name) t. e & 1 Y 1 P r t Fed ef •9 V\i • PEOPLE INFORMATION PROPERTY NAME �, l'1/4-`-P (/ PRIMARY PHONE OWNER (�WJPuke- EC.461 3 l-_ I1".�a('C Ch--C ( ) - MAILING 416D * CITY,STATE,'DO KC (�ct.rru:M.. . `�fw , S _ LOIN 4ea tot CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE C J r y eyi Carte., Int. ( Tqc-oWA, ( 247) (4.7- MAILING ADDRESS COY,STATE,ZIP CELL PHONE a�(°i Atttili c.. S� Tai w., , . ( ) - CITY OF FE RIC AL WAY BUSINESS LICENSE NUMBER © EXPIRATION DATE FAX NUMBER L1 -C - f L, % 42 3 -t L / / (2i92)(97/1 2, 1G CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE C Ti- .i" E L T 41,o 3.- / / 4 APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE A�j ,t r.,ipl�C 6viru✓i.eze K&t" i D'f Nectr ( 2640)14( -14-or- pVC)�C.��// vY MAILING ADDRESS CITY,STATE,ZIP CELL PHONE e)t,) 7\C iii• t fp`"` A)e `� *' lc.(; SecctF{e, W/� ( ) - f-• FAX NUMBER RELATIONSHIP TO PROJECT ❑ Architect 0 Tenant 0-Agent ❑ Oth (Describe) ('040) 291 - l' uD CONTACT NAME r PRIMARY PHONE E MAIL ADDRESS JOkV1 �jvll��KKe h ( 4') 2J1I 14- SSOIbex kviAcOSi,vvelk erilkkt-a( LENDER i - fa, k` , r NAME , CUW g 1l�' t3 BSN£ fhl MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) - ■ DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE �(I EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ t I l V W• SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES 0 NO WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER o LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ. FT. BASEMENT FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE 0 CARPORT❑ EXISTING PROPOSED TOTAL TOTAL EXISTDIG SP TOTAL PROPOSED SP TOTAL SF NUMBER OF FLOORS **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 futures 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(or Tub/Shower Combo) SHOWERS WATER CLOSETS tmueq MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS(Bathroom Sins) 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/TITL ffrIt� , Y��/�1� }� l�(�t' DATE / IS gn ) RELATIONSHIP TO PROJECT 0 Owner 0 Agent 0 Contractor 0 Architect ❑ Other FOR OFFICE VSE ONLY a NEW o ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT BUILDING SHELL ONLY? a YES a NO BASIC PLAN? ❑YES a NO ZONING DESIGNATION CHANGE OF USE? n YES a NO NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO PLATTED LOT? o YES a NO DEMO PERMIT REQUIRED? a YES o NO Bulletin#100-January 1,2006 Page 2 of 4 k\Handouts\Permit Application