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06-104683 • RECEIVD • Federal Way SEP 1 5 2006 06(0 - 1 0_ :3 OF FEDERAL w: PERMIT SF MF CO ME EL PL DE EN-0COMMUNITY DEVELOPMENTS }TY E 33325 8T,AVENUE SOUTH•PO BOX9SAJILDING DEP - FEDERAL 07Y,FAX 53-83-9718 APPLICATION D 253-8 FEDE AL WAY, FAX 253-835-2609 wttni,elhtof(ederrdwai(.COM The following is required information-an incom•lete a••lication will not be acce•ted. Please •rint le•ibl (in ink) r . • PROPERTY INFORMATION SITE ADDRESS ;cl 2 rS f; .. CO On M C,,,•g Sk e F — S SUITE/UNIT# ' - S ASSESSOR'S TAX/PARCEL# 17 (0 2 Z y U - 0 d / 0 LOT SIZE(s/) LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) ' Iclei1.. 1ec.wCi "4oc„A--ia,`S of t e_ec_ V•l,bur,E—' (Attach separate page for lengthy Legal description) • PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING © FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu) Zr•-5-Va_q a:A-i I=NS C.1r -c_Lr 'e 0.I0•7 WA. SCA I>*e. PROJECT NAME(Name of Business or Owner Last Name) 11,t c1 l b C.,;`y C( L,..,,ivck\ei v�.3 VAC, ' ,s.J Q II PEOPLE INFORMATION PROPERTY NAME ^� PRIMARY PHONE OWNER �\Gl� ytq,....a� 'CCcrcck',ciK„»'t i (200 ) tlkl - dot, MAILING ADDRESS CITY,STATE.ZIP -7 CE /73 r1 5-i, PQ.-1r'fevl LA-49. 'it 05 E` CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE ,:.,:-fit,' 1:::re. 5gs,-Ve.v.s wk.elk. L-el :vim `-c,rle-> (z 3 )`1247 - Ill'0 MAILING ADDRESS CITY,STATE,ZIP CELL PHONE (i CSC' - kt1.'. •A-e- eL \s'_i`o4,,.x•1 t �,; A, 9$142`/ (AY) ) (.of-. -ea.t- CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER - B L / / (ZS3 ) V H -023 yo CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE M. - 'T t--1 S 9 i i4 / z, / 207.4 APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE c4,..:tV\ r re- S 414 eiNw s V►kR1- ‘L-e c `�cjr k 1 (4s-3 ) 9 /S 6 t MAILING ADDRESS CITY,STATE,ZIP CELL PHONE i1 bc, 544E A,e_ .ci. •T -c_ow,q I w w , 9gLay ( 25-)) 40(o -92 et. RELATIONSHIP TO PROJECT FAX NUMBER ❑ Architect 0 Tenant prAgent 0 Other(Describe) ( 3) `/le -0135-Z , CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS e - . t)CA-f toCi> ( ' >) Clot - LENDER Per RCW 19.27.095: Lender information is NAME required(fproject value exceeds$5,000 MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) - NI DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ i Crt-`1.-) SPRINKLERED BUILDING? q YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES etr NO WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE D TACOMA D PRIVATE(WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC) III, PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ. FT. BASEMENT FIRST 5:1 -G ` SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE ❑ CARPORT❑ EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF NUMBER OF FLOORS ( (/( **NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ FIXTURES Indicate number of each type offixture 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(commerelai) WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS ior Tub/Shower Combo) SHOWERS WATER CLOSETS(Toilet) 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 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 e"--1/:--- SCr/ /lLLtr L :-e DATE / S//Cj? (Signature) (Title) RELATIONSHIP TO PROJECT ❑ Owner ❑Agent contractor ❑Architect ❑ Other FOR OFFICE USE ONLY ❑NEW a ADDITION ❑ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT BUILDING SHELL ONLY? ❑YES a NO BASIC PLAN? a YES o NO ZONING DESIGNATION CHANGE OF USE? ❑YES o NO NEW ADDRESS REQUIRED? o YES ❑NO UP/SEPA/SU? a YES ❑NO PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? a YES ❑NO Bulletin#100-January 1,2006 Page 2 of 4 k\Handouts\Permit Application