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06-101379 CITY oc `` i , illE - ! 3 ( 7 9 Federal WayRECEIVE PERMIT SF MF CO ME EL PL DE ENC) COMMUNITY DEVELOPMENT SERVICES 3332FEDERAL Y, A98063-97188971UAR 2 ? APPLICATION In 253835-2607•FAX 253-835-2609 wwwcitgoffederalwa q.com CITY or ,_WAi The oliowin• is re. i 7--(stn ormatioiIT an incom•lete a..lication will not be acce•ted. Please •rint le•ibl (in ink)or ••. 7 • PROPERTY INFORMATION p� SITE ADDRESS d! •o 6 .d 333 r/ ) 9j�Q03 SUITE/UNIT# //// ASSESSOR'S TAX/PARCEL # I 7 2 I 0 1 — .9 I '3 8 LOT SIZE(s/) /9/4,4- ' LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) felt c-i'..I 11/a7 Co"ire.v.'11 Ce-A-4"-- (Attach e...1c✓(Attach separate page for lengthy legal description) IN PROJECT INFORMATION TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION D ELECTRICAL D ENGINEERING (1'FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on/on this permit°niitO FI rL V ' -i'A1.- i- C e-ic,✓GG rL.IO�I/� , Front 1 /YRtir?'1-,I4 OgCe-fr 1 Spr/c/A-(er' 5-47'r`7" 4,v& Sir 6"-v/rt174(04J Witt CGi .-,v, ha-t Fti/ F PROJECT NAME(Name of Business or Owner Last Name) Fc/n I -'cy Cc4.eGr,v,'ty C'�v7Lev" • PEOPLE INFORMATION PROPERTY NAMEPRIMARY PHONE OWNER nfr 0l / /✓s / Wet/ (2r5 ) Sf35 -V / MAILING ADDRESS CITY,STATE,ZIP po.a 9709, ,c' 4 ' X01/ , w4) gee 3 CONTRACTOR COMPANY NAME /� APPLICANT NAME OFFICE PHONE ,1b54+e✓- Loi✓f-/'ufi#•0,✓' -774 c. Gla !.1 (25) ) i+'6 -33/'' MAILINGADDRESS CITY,STATE,ZIP CELL PHONE '7e s, 333rac Fa/enl V'', /Poo 3 _ (233 ) C�af - o0// CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER Z 0 - 0 I - i 0 q 2- (7 0 - B L )z 1 3/ 1 06 (2 3 ) , 33— -37P, CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE W A Lrtr,i6 C60/-40546 C- 3'/5p' / / • APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE 4e4tee etiAr f r-o e¢,'m../ ibev c, ( ) _ MAILING ADDRESS CITY,STATE,ZIP CELL PHONE Ste A`or[. Aare. ( ) - RELATIONSHIP TO PROJECT FAX NUMBER 0 Architect ❑ Tenant 0 Agent fX1 Other(Describe) edr-v It va eh fr ( ) - CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS T$ Cally ‘ a� (--f'3 ) 4F '6 - 33lY. LENDER Per RCW 19.27.095: Lender information is NAME required if project value exceeds$5,000 5 c f Co •—,L f. MAILING ADDRESS CITY,STATE,ZIP PHONE 1/45 (sit T4 F'1' 41', Rel t,.,,r() 14 yap&rz (ic ) 976 - 005 • DETAILED BUILDING INFORMATION EXISTING USE A4 PROPOSED USE ,V�/CG✓ C/r.-fT//rvG t'en/ EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 3507 6P 4 s SPRINKLERED BUILDING? ,Q YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES o NO yi` WATER SERVICE PROVIDER / LAKEHAVEN 0 HIGHLINE C) TACOMA n PRIVATE(WELL) SEWER SERVICE PROVIDER XLAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) • s PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED •TAL SQ.FT. SQ. FT. SQ.FT. BASEMENT FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) / GARAGE El CARPORT❑ / MISTING PROPOSED OTAL TOTAL Sfi 1NG Sr - TOTAL PROPOSED Sr TOTAL sr / **NEW HOMES ONLY** NUMBER OF BEDROOMS E ' MATE! SELLING PRICE $ IV FIXTURES Indicate number of each type of fixture to be installed or relocated as part of tht; Project. Do not include existing fixtures to remain. MECFIAJVICAL Value of Mechanical Work $ • AIR HANDLING UNITS EVAPO'/TIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS F . HOODS icoinrierriaq WOODSTOVES BOILERS ' REPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS(or Tub/ShowerC .,bo) SHOWERS WATER CLOSETS(-rodeo C(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTL . SUMPS RAINWATER SYST WASHING MA 'INES URINALS HOSE BIBBS LAVS(Bathro .,Sys) 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/TITLE Ziff' '�' `� �/b(j1 74 mrotr'i,,ef© ' DATE (Signature) (Title) RELATIONSHIP TO PROJECT 0 Owner 0 Agent ,,Contractor 0 Architect 0 Other FOR OFFICE USE ONLY a NEW ❑ADDITION o ALTERATION ❑REPAIR a TENANT IMPROVEMENT BUILDING SHELL ONLY? o YES o NO BASIC PLAN? a YES a NO ZONING DESIGNATION CHANGE OF USE? o YES a NO NEW ADDRESS REQUIRED? o YES a NO UP/SEPA/SU? a YES a NO PLATTED LOT? a YES o NO - DEMO PERMIT REQUIRED? a YES a NO Bulletin#100-January 1,2006 Page 2 of 4 k\Handouts\Permit Application