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05-103144 RECE D 111. r0 ST - _Loi � iLt. CITY OF • Federal Way JUN 3 0 2005 PERMIT COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE EN 33325 8I. FEDERAL WAYWAIH•POBOX97J8 APPLICATION '� FEDERAL WAY,WA 9806 OF FEDERA ! 253-83n5w-2c6u07o•(kFdAXr2J5m3.m5-m2e$ U LDING DEPT: / / • The ollowin• is •uired in ormation-an incom•lete a••lication will not be acce•ted. Please •rint legibly(in ink)or • PROPERTY INFORMATION SITE ADDRESS '. 0.L S e' I 4)7.4 ft,/E S. 4 q 3 t7>°) ''®0 3 SUITE/UNIT# ‘e? ASSESSOR'S TAX/PARCEL# 0 2 1 0 - 2. ( LOT SIZE(sf) 44-) 3 el LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)00.2.104 23I/J 150E`T OF SO)4 of NE%$ of SE OF JE %} i- c tci (Attach separate P Jefar le jthq legal description) Pa"> • PROJECT INFORMATION TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 'FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit onll{)/ �^ / T1 o 1-.0- L �jEr.) f I'k e cpp,..►KLGQ SyS-i t A..10 1Di`y `�'TA-LPPi PE. 1hJ EA .3-- 617-4gat-J1=1,..1.� 1..3 !x15-r-1.I() t �,•ras.Y r(o.s4E APAg.TM .I°r Ri-OC-7 . PROJECT NAME(Name of Business or Owner Last Name) /1'+-IrlRIC't.:1 E. Ltpty3‘z APi i Ni g-iTS 61-CHA) I. PEOPLE INFORMATION PROPERTY NAME /A PRIMARY PHONE OWNER 1rJC CYJUr� -�-1VUStr,6, /-I+-ITrt-orain) 4Pr•►!wt. ( ) MAILING ADDRESS I n/� C .STATE,ZIP bob JCaiE f- >• TLa k----)A 6)b it"?' CONTRACTOR COMPANY NAME � IAPPLY'ANT NAME / OFFICE PHONE 6C. '/7rprrs rR� ()tv;'. t'r ARrt.� (_jr7�'-c'K-% (�25 )eel r�lUt� MAILING ADDRESS CITY.STATE,ZIP CELL PHONE 7102 I Crr" AJE riE 5 TE•P 105 EDMa•.113,JA °).,052 (425) `7 3i- -e2 15 CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER t ' —q °)— I 0 1 -B L 12 / 31 /0G (425)t30i - 3030 CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE 1-4 E S i E S F t 3 Lo ge F 12 / 31 /PS APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE ..11rAE M. ASO 1.1F- ( ) - MAILING ADDRESS CITY.STATE,ZIP CELL PHONE ( ) RELATIONSHIP TO PROJECT FAX NUMBER ❑Architect ❑Tenant XAgent ❑ Other(Describe) ( ) - CONTACT NAME PRIMARY PHONE E- LADDRESS 14eTi �L'fLI-(l`,)LI (`� .5) 73& 02.154‘K7ieJ SOKLLSKI Pi4SFP> OS LENDERPerIMW19.27.099 Lender i nnationte NAME required if predect vane exceeds:$5,000 MAILING ADDRESS CITY.STATE.ZIP A • DETAILED BUILDING INFORMATION n EXISTING USE f-1 PnQr ..•.1 i S PROPOSED USE /�P A47-7"46--i r5 EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ I S 0, O SPRINKLERED BUILDING? ❑YES NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? $YES ❑ NO • WATER SERVICE PROVIDER 51.LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER I3(LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) W. PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL Sg.FT. Sg. FT. Sg.FT. BASEMENT FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE ❑ CARPORT❑ EXISTINGNUMBER OF FLOORS PROPOSED TOTAL rcn wexasaING SF OoTu rxoroern earTOTAL SF **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. MECHANICAL Value of Mechanical Work $ AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOODS(comm.-dm WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS moue) MISC(Describe) • DISHWASHERS SINKS SUMPS DRINKING FOUNTAINS GAS PIPE OUTLETS 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 ► DATE (Signature) 11 (Mlle) RELATIONSHIP TO PROJECT ❑ Owner El Agent O Contractor ❑Architect ❑ Other ........................................................................ ........................................................................ •POR OEPICEMSE::ONL'Y n NEW a ADDITION a ALTERATION ©::REPAIR. s a TENANT IMPROVEMENT BUILD SHELLS ONLY? a YES t NO BASIC P AN? a YES ❑NO ZONING DESIGNATION CHANGE OF USE?. a YES ❑NO ,NSW ADDRESS R }UIRED? ❑7tES ©N<1; it JSEPA%$n'� a YES o NO • :PLATTED LOT? a YES:: ci NG<: DEMO PERMIT REQUIRED? a YES a NO • Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application PJ?