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05-105255 009\4,), f Federal Way REG EI - . �- PERMIT COMMUMTYDEVELOPMEA sERVICES SF MF CO ME EL PL DE FP+ 33345 D AVEAUE, 9•POBOX 97180 C T Z APPLICATION FEDERAL WAV,FAX 53435-60 U 253-835-2607•FAX 453.835-4609 l°totu.city°B"ede' 'a`°mCITY OF FEDERAL WAY ® 5 1 0 5 5 The ollowi • is re•ubF{)I *• •r 1,an Inco •fete • ••licatlon will not be acce•ted. Please.•rint le•ibf in in or PROPERTY INFORMATION p SITE ADDRESS 34'f 7C,ci 9'44" Ave S 45,...,4-L. SUITE/UNIT# (S.'-3oo ASSESSOR'S TAX/PARCEL# — LOT SIZE Of) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate pagefcr lengthy legal deamPdon) ■ PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING ❑ MECHANICAL - 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING AFIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) Lt is j( (3) S wko k t° b r�-e c rt.�.: CzA • iL� ?Y1 e., es cis,tA 2. s+ii rabc_ -i-n L c r s L'� .T S c LA I Ae " — 2f3(..2 r=tiNr .\.L' • t. PROJECT NAME(Name of Business or Owner Last Name) Sr)(Ad-L -S©(.A u Q c j �t.J;G i Vel' - $ PEOPLE INFORMATION PROPERTY NAME PRIMARY PHONE OWNER ( ) - MAILING ADDRESS I CITY,STATE,ZIP CONTRACTOR COMPANY NAME L,N"5_$.1e,. !``t c.4-ftl:+tn t C S APPLICANT NAME q le_tOFFICE PHONE MAILING ADDRESS Q_c'(t e S. LA-0._2y D itJ�c( I�L2a(, ) 331 - 7,01 CITY,STATE, IP CELL PHONE 1.1728' 9a :c Al• S . k use. crg(33 (o+P(0)36 t{ 191.8' CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER © EXPIRATION DATE FAX NUMBER 2d - ® S-1 !3 1 a i �-•B © !2 /3 ( /2 '( )Stn - ' NTRACTyORS REGISTRATION NUMBER(cooppy of card required with each application) EXPIRATION DATE APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE 541-vv£ 1-1-s ,A4 o c _ MAILING ADDRESS CITY,STATE,ZIP CELL PHONE RELATIONSHIP TO PROJECT ( ) FAX NUMBER ❑Architect ❑Tenant ❑Agent 0 Other(Describe) ( ) _ CONTACT NAM o PRIMARY PHONE DRESS �Jec�( (a0(©) 331 - 7 (D I - h 'k- LENDER ?, -.d.3 , gees std. l vi ae rTCJ,ttri' _r17,x., NAME MAILING ADDRESS CITY,STATE,ZIP ■ DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED I VALUE $ VALUE OF PROPOSED WORK $ 'ZZ©Q )i SPRINKLERED BUILDING? YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES 0 NO WATER SERVICE PROVIDER o LAKEHAVEN 0 HIGHLINE ❑TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER o LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC) • PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST et C 2-(e, ( SECOND \ 'rte 1 THIRD FOURTH • ADDITIONAL FLOORS(DESCRIBE) • DECK(COVERED?) GARAGE 0 CARPORT 0 Emma PROPOSED TOTAL t R EDifr NUMBER OF FLOORS • z `".;. •' **NEW HOMES ONLYY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ FIXTURES Indicate number of each type offixture 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(commerci4 WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS(or TVb/Shower Combo) SHOWERS WATER CLOSETS(roves 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 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 EZ�yrip DATE g""( � Signature) (Title) RELATIONSHIP PROJECT ❑ Owner 0 Agent ❑ Contractor ❑ Architect ❑ Other @. 1! ;fit)L')1'''(4,4 a 5 VAIa t alo P+ ql44-1").!`"' >n51 '44' 4 t[i t,gtic ��iz r � `" 4�` 4p raJ�P4(s3 ® 9(.00,Aiit6)4 7- � t `t o-i ;4:1-61.4 'CO) " rf.r;)Ot4.:*C3i 5r,M 0 N.:/'r t''eAt Tee; pro 370:` f.;-51.5 6 r_��ar ��t �foY7 Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application