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05-103497 II/ CITY of 05 1 /�V 3 ' ft 7 Federal WayDAII, COMMUNI7S'DEVEIAPMEIVTSERVICES�;1 1 $ '1°5 PERMIT SF MF CO ME EL PL iI E E ' FP 33325 8TH AVENUE SOUTH•pig 63 BOX 971 �Ep F P P L r C A T I O N FEDERAL WAY,WA 98063-9718 E� / 253-835-2607•FAX 253-835-2609 / www.atuofederalway.com ,�. ,MNG�� The ollowt • is re•uirevd in ormation-an incom.tete a.•lication will not be acce•ted. Please .rint le.ibl (in in or •e. C , IN PROPERTY INFORMATION • SITE ADDRESS 08� ' / /4Ue .5,; SUITE/UNIT# ASSESSOR'S TAX/PARCEL# © S Z ( 6 4 _ 7 3 /a_75 LOT SIZE(sf) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal desoip[iom) ■ PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING t.FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide`tailed d cription of work included on this permit only) PROJECT NAME(Name of Business or Owner Last Name) J Ci V ,ee g-e._ USS "09,0a pt. en- • PEOPLE.INFORMATION PROPERTY NAME. // PRIMARY PHONE OWNER F-1/) CO(.Jd1 LI/OZ)‘ MAILING ADDREgS �l� I (— So ) -/� �. � CITY STATE,�lP CQ?S 4 'e�/°Grlc 4J e 73'7 4..)i ?&83 CONTRACTOR COMPANY NAME . PLICAN ME OFFICE PHONE CTL a:1_5'l ss ..)ducct-v (2-‘4"...)c z -cam V MAILING ADDR CITY,STATA ZIPCELL PHONE •c e. ,,c-i� J c- /u- :...5- G•- '5'9/.0i (20c)ifs b Y -3c CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER _ EXPIRATION DATE - FAX NUMBER - - 's L / I . ( )CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE APPLICANT COMPANY NAME ,,�� APPLICANT NAME OFFICE PHONE :SC'/�p C_$ CG.1 )cc?c - ' ( ) _ MAILING ADDRESS CITY,STATE,ZIP — CELL PHONE RELATIONSHIP TO PROJECT ( ) FAX NUMBER 0 Architect ❑ Tenant ❑Agent 0 Other(Describe) ( ) - CONTACT ( NAN� PRIMARY PHONE - AIL DR( 4').34`C% '�F4'7'7 I i'EM'0:�...ADjc y.0 ESS,to w c C/cv(cic c... LENDER r -- :>09 ori ` f NAME ;f e ue'e e ��'OI * MAILING ADDRESS CITY,STATE,ZIP . . • . . I. DETAILED BUILDING INFORMATION . EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK s3Df GO SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) _ L„ Q SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) ( -- r C • , PROJECT FLOOR AREAS �} AREA DESCRIPTION EXISTING PROPOSEDTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST SECOND rr THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) • DECK(COVERED?) GARAGE ❑ CARPORT 0 LXISTINO PROPOSED TOTAL `" TOTA"'asTD&.F kVVOT.IL PROPOSED SF Arg NUMBER OF FLOORS 0 ,y,.* - � ,04.47,-7.11,1 **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(commercial( WOODSTOVES _ BOILERS ..., FIREPLACE INSERTS RANGES MISC(Describe) COMPRESS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING THTUBS(or Tub/Shower combo( SHOWERS WATER CLOSETS(Nilo MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS / LAVS(eathroomSinks) 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 applica / NAME/TITLE �- - DATE 7//(< li (Signnre) (Title) I c RELATIONSHIP TO PROJECT ❑ Owner 0 Agent contractor ❑ Architect 0 Other • 4 IaI ` E'O D E '4,-.7t: Ab T,O : N IZE ATR - i i • rar;r4T g ,,� �,� "''��:`®®dr.�:",° _'�' b.�Fh a: .CwK u1�' ,:7;' nY R'* 1 T' . 'dL A�k'� 2. ✓Gn NY `- � (� ,'�{� ��� %^ D o G4SHE: - �..® Q • '#; '" v .ik.%'P i d �'=R".* b. 4 ° GNATIO . . _ 6. O,� G Q. __ � �'ES: ,s • ,., ® ° 11 iii R '77:7,,,,, • " SEPAL SU? ° 4 • g. , •' x 77- ,--'4E) � ." ria T 4. Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application