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05-103142 �troF.� 11_19 l Q S f 14 Federal Way JUN �J PERMIT coMMUMTYDEVELOPMERTSERVICES JUN J 0 2005 SF MF CO ME EL PL DE E 9 33325 8,11 AVENUE SOUTH•PO BOX 9718 _ I,L I C AT I O N FEDERAL WAY,WA 9 8 063-9 718 TD 253-835-2607•FAX 253-835-26)iT Y OF F E D E / / www.eityoffederalwau.com BUILDING DEPT. The ollowi • is re•uired in ormation-an inco •fete a.•lication will not be acce•ted. Please •tint le•ibl in in or • PROPERTY INFORMATION SITE ADDRESS 4::: 16:22 D E SUITE/UNIT# ASSESSOR'S TAX/PARCEL# I 6 2 1 04 cid O f 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 0 ELECTRICAL 0 ENGINEERING [4IRE PREVENTION SYSTEM PROJECT D CRIPTIONouide detailed description of work included on this permit onli() ..r.A. Z( Lit' ( Ct 11 ) AJC W Co-u-1 43265 PROJECT NAME(Name of Business or Owner Last Name) 4k111//4-- ./ U PEOPLE INFORMATION PROPERTY NAM / � A PRIMARY PHONE OWNER � "`t-K V�_ __( 'l- ( ) - A4AIhING©AD��S ���� CITY,STATE,ZIP �e-ri 18124 CONTRACTOR COIFIPANY NAME ICANT NAME � OFF CE PHON t7L:C i- ,a)Lia,T (41Z5) - MR�iy�G RESS �5 ATE,ZIP 2 CELL PHONE TO �Cx -iri it ft- �cM (Za ,) Z* - �f6 CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATIO4 DATE - FAX NUMBER i l - jt - 000 00I-B L / / ( ) - NTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE › V APF? t 1 1 B. b .5-1 of /O- APPLICANT APPLICANT ANY NAME n t APPLICANT NAM OFFICE PHO E ViliZ5)Y1,3 -05'7 MAILING ADDRESS l STA E,ZIP + - CELL PHONE pa I�ox /5'f3 fid, /,, � z 77072 ( ) - RELATIONSHIP TO PROJECT , FAX NUMBER ❑ Architect o Tenant ❑Agent 8/Other(Describe)Pel'' 1I'`/Gael— ( )G - ONTACT NAME4, (4/20 H EJ -5-�� //„6p� �����.77' E-MAIL ADDRESS LENDER z rZ0e, 9 't l��r P r t�<" �r , NAME � ' ,,--(,,Q , ,,,,:-4A r_-..,, 4x4",`-X. 'y ar l'Z. . W MAILING ADDRESS CITY,STATE,ZIP -- j • DETAILED BUILDING INFORMATION EXISTING USE 6eZ PROPOSED USE Cry EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ o'52-6,S- SPRINKLERED BUILDING? GYMS 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES a NO WATER SERVICE PROVIDER ❑ LAKEHAVEN a HIGHLINE 0 TACOMA a PRIVATE(WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN a HIGHLINE 0 PRIVATE(SEPTIC) PROJECT FLOOR AREAS SED SQ.FT. AREA DESCRIPTION EXISTING PROPOTOTAL SQ.FT. SQ.FT. -BASEMENT FIRST SECOND THIRD • FOURTH • ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE 0 CARPORT❑ EXIST 0 PROPOSED . AL�ROPOSED 9r °'` "3' AL 6r NUMBER OF FLOORS „� ... "•NEW HOMES ONLY** NUMBER OF BEDR MS ESTIMATED SELLING PRICE $ FIXTURES Indicate number of each type of f xture to b tape. relocated as part of this project. Do not include existing fixtures to remain. MECHANICAL Value of Mechanical Work $ AIR HANDLIN TS EVAPORATIVE COOLERS LOGS REFRIG.SYSTEMS BBQS FANS HOOD ....�,c;aq WOODSTOVES ERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEAT DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS(or Tub/shower Combo) SHOWERS WATER CLOSETS froitey MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAYS(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 if" o 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 4- 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 '4- 1 DATE (Sign Lure) (Title) RELATIONSHIP TO PROJECT ❑ Owner ❑Agent l�ontractor 0 Architect ❑ Other 8 .!� °_s3 �8 ® 0,04d a� �. �� � r-)14-4-.:',1,21- ,,x„,,,....,' � 4a�') d`! .u'�-�' A^"�„>����,,����1<� ���� �3kF �9�,i.,p�®.�� y��� �r c. '7� � e+.>.. 3J .-,'-z..'-7 .,.```�awa 2 ---7 �� r�.�.rE,.a' � "`^;A °J�„g F; gl Q r E e�� €Ii3a {� �TF" - 4 ..s.. i..* _ • y� r � Tali :;tl® e 1._----7,j4-61.- -.1,10,:.:41,11„-s--ae ® e E,--t-,-,,,,-- o �, � ® �.. W,..��. ,�.�.�..a:,.4,e,.€� w.ate:' .77 ... ...,....o.,ch�.0 .� ...,.,...,:.b-;a Bulletin#100-January 7,2005 Page 2 of 4 k\Handouts\Permit Application