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06-105593r e „,, e.Nie 11. / Ce-- 1 (),G --9-- -) Federalway� � 6 PERW 1�r _F a'`/�(! COMMUNHY DEVELOPMENT SERVICES �QQ O eMFELTDE EN FP �/ 333258^/AVEM7ESOI71H•PO BOX B7IQ�'( �I 1 • ��l� � oo� T.FEDERAL WAY,WA 98063-9718 U 1 4PLI C N / / 253-835-2607•FAX 25&835-2609 f'��!( uiiuu.Jua��edera2ma4.cain v, )�p�Vt pF�yq� The ofowin' is r.,' : ,i.e.' '.' , -an into ,tete , ,a Iication will rtbt be acne,ted. Please , • t Let•'1. (in ink)or . ,•. ' ?21:5 ")(-72-4(;) y III PROPERTY INFORMATION SITE ADDRESS / 7W SUITE/UNIT# d ASSESSOR'S TAX/PARCEL"# / 2- ''.1:)/ - q / I , -LOT SIZE(4) I-9)`425 LEGAL DESCRIPTION(e.g.Acme Estal�s.Lot 1) 51C- _ - -Hi-0 Watch separatepageJ lengthy legal description! '.. ® PROJECT INFORMATION TYPE OF PERMIT BUILDING ❑PLUMBING ❑ MECHANICAL a- . :;I, OLITION U ELECTRICAL U ENGINEERING D FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this ''rmit ons , tJ PROJECT NAME(Name of Business or Owner Last Name) ALS`' ,.)V,:-1(:22/,...) M PEOPLE INFORMATION PROPERTY NAME PRIMARY PHONE OWNER IM.A/.-V�IL�C%r� / ,z,(261-- VAN09)�.•-e' (? ')11/..--- 5.2..e ) -MAILING ADDRESSCfY.STATE.ZIP pC3 2-v '2-etii R �'�LV t. ,/L wAki1, w74" LPG-,2:? CONTRAI,TOR COMPANY NAME APPLICANT NAME OFFICE PHONE 1? 2 •,404-&.fttd ( ) _\ HARING ..a.••a>:. IL,ZIP - �� "0,..1.- 3 f 7l1OF FEEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX -.:i:, k2.5) - _ - / / ( ) 1 — — B L // _ CONTRACTOR�REGR7IiATI���eoPY�o[aardr�£h each application) / � /� ��/[RA'IYON�DATE I' APPLICANT COMPANY NAME APPLICANT NAME ((( OFFICE PHONE H Nl vv AA ( - 'Je1^.ttll,,.. r?-0 3l �� 2--I V12 MAILING ADDRESS - COY,STATE,ZIP CELL PHONE I I G2.- I '[1 Ave - tI WA 1e8112.-- (26)61—l' —0221 RELATIONSHIP TO PROJECT - FAX NUMBER XArehitect ci Tenant o Agent E Other(Describe) QeJ<J)71,,,?0,.. -55' 16' I CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS �.. H k IJ P ( 322. I M2,-- a'C- , a)I tiNJ ,(e)il LENDER 'P'er*rte" ,00`. ASE ' 1' tiN1dS : NAME regmre4f if prgject value iris-$6.000 MAILING ADDRESS CITY."STATE.ZIP PHONE ( N DETAILED BUILDING INFORMATION //��� KRISTIN tr USE / ,AA Li i' PROPOSED USE I" )U EICISTUVG ASSESSED/APPRAISED VALUE $ ?0041000 VALUE OF PROPOSED WORK '$ ?--C/j/ 000 SPRINKLERED BUILDING? ❑YES (NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES ,KNO , WATER SERVICE.PROVIDER YLAKEHAVEN 0:HIGHLINE a TACOMA a PRIVATE(WELL) SEWER SERVICE-PROVIDER a LAKEBAVEN ❑HIGHLINE XPRIVATE(SEPTIC} �� ,� o� 1 PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST 011\II P.f(7, I r SEeefii3 6,A Z,.-e '2'47 9 1,0 THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE 0 CARPORT 0 NUMBER OF FLOORS snarmc Paoeoem u TOTAL Tar =ATOM sr TOTe* sr' ros **NEW HOMES ONLY" NUMBER OF BEDROOMS I 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 Valve of Mechanical Work AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS 3 REFRIG.SYSTEMS BBQS FANS HOODS)comamerdal) WOODSTOVES BOILERS FIREPLACE INSERTS/ j RANGES MISC(Describe) COMPRESSORS ry • ACES I GAS WATER HEATERS DUCuu G •PE R i EIS PLUMBING BATHTUBS los mb/Sbowrrcombo) SHOWERS ' WATER CLOSETS pone) MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS I GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MAC s'✓. URINALS HOSE BIBBS LAVS(eamr...i sink.) VACUUM BREAKERS ELECTRIC WATER HEATERS DISCLAIMER/SIGNATURE BLOCK I certifyunder penalty'ofperjury that the infbrmationfurnished 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 - V _ A DATE 10All rJfo, {Signature) / (flue) RELATIONS i e' TO ' 'OJECT a Owner ❑Agent ❑ Contractor 'd Architect ❑ Other 1 I'OR OFFICE PNE ONLY a NEW n ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT BUILDING SHELL ONLY? o YES o NO BASIC PLAN? n YES ©NO ZONING DESIGNATION CHANGE OF USE? n YES n NO NEW ADDRESS REQUIRED? a YES n NO UP/SEPA/SU?, n YES a NO PLATTED LOT? a FES ❑NO DEMO PERMIT REQUIRED? a TES? a NO Bulletin#100—January I,2006 Page 2 of 4 k1E1andouts\Perrnit Application