07-106403 RES*/ D all
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Federal Way NOV 2 9 13-1pRMIT1% MIT Z — �� ��
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE EN '
33325 8"AVENUE SOUTH•PO BOX 9718 �•—
FEDERAL WAY.WA 98063-9718 ' 1:' A P Pt I C AT I 0 N / /
253-835-2607•FAX 253-835-2609 ,
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS o I)1O I a i &U 6( SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 0 r ¶ 1 - i g LOT SIZE(s
G`) /L/O1//y2 9
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) -Mir ck1 Wag CondvS 8/At t(,�`/�/1f
(Attach separate page f lengthy legal description)
■ PROJECT INFORMATION aaaJJJ
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION ❑ ELECTRICAL 0 ENGINEERING X FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of wok included on this permit onlil)
5m6-Ah dire Std -Fetus f.(ji l `�('ovi e (I�Lou+ pipe. -Fire rotedio(1 SprinEter
s Skrn f roteC'1- s� m �(or O4 4 i b (�dtvl
-7-6(1)46/1145 - Biala 1
PROJECT NAME(Name of Business or Owner Last Name) t 9 Ctera l W 6^ iloigiglers
• PEOPLE INFORMATION
PROPERTY NAME a('b PRI Y P N
OWNER !NG
oc'te-i1-1 '� V �� 1, t._ 93 J
� t E-MAIL ADDRESS
,Cr36.''' ___g 1\)tZ 9_S(3' Ci- ru,-' -
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
5rn*r Fire- Aveti& ems Sh�le(4( Icss�man (�s(, --3) a'yg -a�Y7'7
LING ADDRESS
5- 1111 V`g 7&co1))�.f W/9 92#21/ (IP ELL PHONE
1AVW
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPI TION DATE FAX NUMBER
/p 27-O0005c 00 -- /2%3Ve'7 ) 90--23so
CONTRA/CTOO�R'S RREE/GII]STRA�OON`NUMBEER�//��-�^/�'— EXPIRATION E-MAIL ADDRESS
COPY of card required /r/' .f/! " V / lY V I / �/(q l� Q/,3 ��.►/j�f/'(\��}'.'�{I'y�/^n �.}/�
with each appliutlou 4/1 � Ji1 /®;J �,5��/bl.l `7�'I�"Vlr�"1 ``f C-'CO/'�
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE /`1� l
' h y}e 54S- MS 11%(`ke-UTE, t C�tc�ss Man (a3 )ai18 -a en
i`� W//07,#:‘/1"
+� m/r 101) � `ELL PHONE
RELATIONSHIP TO PROJECT v �f tT�L t, [•` FAX NUMIBER
❑ Architect 0 Tenant 0 Agent Other /,l�a�� (�53 )� l -3 350
PROJECT NAME ��( /� (/� f /� PRIMARY/' PHONE p E-MAIL�^ ADDRESSp
CONTACT JU��1 / ILS'e ./e` (�) 9 - I geo jisen e ocmore`cLENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE.ZIP PHONE
( )
■ DETAILED BUILDING INFORMATION
EXISTING USE C-0( 605 PROPOSED USE CO(({OS
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 3'71 i/O
SPRINKLERED BUILDING? AYES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? *YES 0 NO
WATER SERVICE PROVIDER XLAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
,�, • PROJECT FLOOR AREAS j
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ.FT. SQ. FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE 0 CARPORT ❑
EXISTING PROPOSED TOTAL TOTAL DUSTING SP TOTAL PROPOSED SP TOTAL SF
NUMBER OF FLOORS
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
I. FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fbctures to remain.
MECHANICAL
Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBgS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS icomme,nap
COMPRESSORS FURNACES RANGES
DUCrs GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or TIM/Shower comm) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSPAS(Tone)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
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. /�/J jet e-�
NAME/TITLE 577/U-K-e �7/( ma/I) DATE ///2g/t/
Signa re) (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent ❑ Contractor 0 Architect Other emp/00Pe
FOR OFFICE USE ONLY
❑NEW ❑ADDITION ❑ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑NO BASIC PLAN? ❑YES ❑NO
ZONING DESIGNATION CHANGE OF USE? o YES a NO
NEW ADDRESS REQUIRED? ❑YES a NO UP/SEPA/SU? ❑YES o NO
PLATTED LOT? o YES a NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100—January 1,2007 Page 2 of 4 k\Handouts\Permit Application