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04-101696 REG EIV 0 _ir2 ___/ CRY Way 40 OA - 0 L �� 0 6 2004 PERMIT SF MF CO ME EL PL DE rligra COMMUNITY DEVELOPMENT SER 33530 FIRST WAY SOUTH•PO BOX 9718 FEDERAL253-661-4115WAY,•FAx2sWA 98063-97189pETD EP / / �E RN-APPLICATION www.cittlofiederalw r�BUILDING The ollowin 1 is 'aired in ormation-an incom•tete • • •lication will not be acce•ted. Please •Tint le! bl n i or t_ • - PROPERTY INFORMATION SITE ADDRESS ;3 / /0 ' A/e ( ,S fy 1/Cp SUITE/UNIT# ASSESSOR'S TAX/PARCEL# ____ _ _ _ _ LOT SIZE(sf) LEGAL DESCRIPTION(e.g. Acme Estates, Lot 1) (Attach separate page for lengthy legal description) PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION •g'iLECTRICAL 0 ENGINEERING 4 FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit onl i) hit V wV 5yff-eAvi PROJECT NAME(Name of Business or Owner Last Name) _, /11977P C.. -4 �i O S e---c..� PEOPLE INFORMATION PROPERTY NAME PRIMARY PHONE OWNER ( ) - MAILING ADDRESS CITY,STATE,ZIP CONTRACTOR COMPANY NAME APPUCANT NAME OFFICE PHONE aIVet'WA_a,Ofric.... (47.5075 59oo LING ADDRESS CITY,STATE,E� ZIT' CELL PHONE j° Ave, Sti' t,veic 117n 418206 ( ) - CITY OF FEDERAL AY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER - - - I / ( ) - B L CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE I / APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE *1eatri c etl2rr t(Id L . } 3 -133) � MNG ADDRESS I CITY,STATE,ZIP R ),i CELL PHONE 10.'.�&XZh( t ©33 (5wrvii 't. W ( ) - RELATIONSHIP TO PROJECT ..rii FAX NUMBER 0 Architect 0 Tenant 0 Agent [°Y Other(Describe)E`r'r.4'1 e & W:kr ( *pa}6(o3 -0 8 ? - CONTACTNAME PRIMARY PHONE E-MAIL ADDRESS 0./ S Ck1�I g (2w) 131 -312.8 �]tal rfreCe terhnd9i*1eii rtel LENDER Per RCW 19.27.095: Lender information is NAME required if project value exceeds$5,000 MAILING ADDRESS CITY,STATE,ZIP DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ r. / e C C SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) • PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL BASEMENT FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS (DESCRIBE) DECK(COVERED?) GARAGE/CARPORT HOW MANY FLOORS? TOTAL EXIST/NG TOTAL PROPOSED TOTAL=canna AND PROPOSED **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 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 rub/shower combo) SHOWERS WATER CLOSETS(Toilet) MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS(Bathroom sink.) 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 F .• a • to any claim(including costs, expenses, and attorneys'fees incurred in the investigation and defense of such claim),which ay be made by • . person,including the undersigned,and filed against the City of Federal Way,but only where such claim arises out of the is of the city,i • luding its officers and employees,upon the accuracy of the information supplied to the city as a part of this application .,AL ,e NAME/TIT ' �'"._ /� ° DATE j -._ e J/ G-- (Si re) (Title) RELATIONSHIP TO PROJECT 0 Owner ,(Agent 0 Contractor ❑ Architect 0 Other FOR OFFICE USE ONLY o NEW ❑ADDITION o ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT BUILDING SHELL ONLY? o YES o NO BASIC PLAN? ❑YES o NO ZONING DESIGNATION CHANGE OF USE? o YES ❑ NO NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? o YES o NO PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? ❑YES ❑NO