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04-101499 crr w` , Lf . Federal Way • pERMIT _ U q SF MF CO ME EL PL DE EN" COMMUI1r{DEVELOPMENT SERVICES x;33530 R WAY SOUTH.Po BOX 9718 APPLICATION FEDERAL WAY,WA 98063-9718 o / 253-6614115• 253b in ww w.d(tp/j'ede a rat wa�.corno m The ollowin• is re.uired in ormation-an inco •fete a..lication will not be acce•ted Please •rant le•ibl (in ink)or .•. PROPERTY INFORMATION . SITE ADDRESS Ck&(rcli 0, (31Q ,‘i1 L{ 1`-()v- SUITE/UNIT# ASSESSOR'S TAX/PARCEL# /7.2 /a9 966/5-5 - LOT SIZE(sf) LEGAL DESCRIPTION (e.g.Acme Estates, Lot 1) (Attach separate page for lengthy/ego./desvipaoc) - PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING ❑ MECHANICAL 0 DEMOLITION 0 ELECTRICAL ❑ ENGINEERIN(t FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu) fk-, 5,firi?,'leg CeOt'c t'©vi PROJECT NAME(Name of Business or Owner Last Name) C `ti r 44 0 )/6' We55%t if e PEOPLE INFORMATION . PROPERTY NAME J �� PRIMARY PHONE OWNER C 're o'J� ��4.2,_r/WVifr or -I l/Sly!( n ( Ob ) 7 tv 7 5 a2 7 MAILING ADDRESS CITY,STATE,ZIP CONTR CO PANY NA X APPLICANT NAME OFFICE PHONE I C .'_.1 LING A DRESS CITY,STATE,ZIP CELL PHONE ( CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER B / / ( L CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE / / APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE ( MAILING ADDRESS CITY,STATE,ZIP CELL PHONE ( RELATIONSHIP TO PROJECT FAX NUMBER 0 Architect 0 Tenant 0 Agent 0 Other(Describe) ( CONTACT NAME iI/ PRIMARY PHONE V t,,;k r c ]_fie f_ t ( E-MAIL ADDRESS ) 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 /1�^J merry EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ �k'(� K/ SPRINKLERED BUILDING? ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? IiNO WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE L3 TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE o PRIVATE(SEPTIC) ti • , PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ. FT. TOTAL ; J. I FIRST SECOND FOURTHIII THIRD ADDITIONAL FLOORS(DESCRIBE) ■ DECK(COVERED?) HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING 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.V 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/show rcombo) SHOWERS WATER CLOSETS Iroieq 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,in d".,g the undersigned,and filed against the City of Federal Way,but only where such claim arises out of the reliance of the city \nrj ding it. o ;cers and employees, upon the accuracy of the information supplied to the city as a part of this application. NAME/TITLE ° ature ' DATE '/Y'(Title) RELATIONSHIP TO PROJECT 0 Gwner 0 Agent 0 Contractor 0 Architect 0 Other FOR OFFICE USE ONLY o NEW a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT BUILDING SHELL ONLY? a YES a NO BASIC PLAN? o YES a NO ZONING DESIGNATION CHANGE OF USE? a YES a NO NEW ADDRESS REQUIRED? o YES a NO UP/SEPA/SU? ❑YES a NO PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? ❑YES ❑NO Bulletin#100—March 30,2004 Page 2 of 4 k\Handouts—Revised\Permit Application