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07-104471` i 6EED cin as ; Federal Way AUG i 0 2007 PERMIT COMMUNITY DEVELOPMENT SERVICES 33325 8TM AVENUE SOUTH • PO BOX 9718 FEDERALWAY WA 98083-97q . �$f 253.835 2607• FAX 253-835-2 ARLI CATI O N mu,BUILDING DEPT. f SF MF CO ME EL PL DE EN The following is required irtformation - an incomplete application will not be accep/ed. Please print legibly (in ink) or type. iiM PROPERTY•• • SITE ADDRESS _Z 1©C) 3 20 - �Tt �.� era' '� y l,J Iq 7K-® i) 3 SUITE/UNIT # � ASSESSOR'S TAX/PARCEL # Z Z Q - Q © S O LOT SIZE (sfl LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) �) ,e S ere f� (Attach s.P—d. Page for Ien9thg k9.1 &-,fptroN PROJECT• • TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of wor k included on this permit oniul i �jm \\� o -e-- 5 ev�S CSFS Wil\\ ctJgll�l) }ne `w dC q e S c,'v�l�)el S Ste— ib nA-r-cf I V H' 1 6'F �' D CQ6 Ct r V GS ere II- x.T /i r. e 1 S�i 1 Ape svno�H ai v\P•o 2," Or" AO�D2, yolwe VA coo sgl*-filer p, De, A>�l\ 10 ns+o/led` X4.0 0�y eXAppKler-S PROJECT NAME (Name of Business or Owner Last Name) U �S r eG� tS� t c S PEOPLE•• • PROPERTY NAME !� C PQ r`J y Oft h S U y Q r (\ \� \ `J PRIMARY PHONE MAILING ADDRESS (!06- 5`l -j -S /}-v,,:, \�C'5-k- OWNER S ( ) - FAX NUMBER S ❑ Architect ❑ Tenant ❑ Agent t)( Other p1 b v e.. e- CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER --C,L MAILING ADDRESS �1 `1F 0 5 3111- rT v,e. 5 , CITY. STATE, ZIP ea 4,1 Wit , Lj,i `?W L(9? E-MAIL ADDRESS CONTRACTOR COPY of card required with each appllcatiou APPLICANT PROJECT CONTACT LENDER COMPANY DAME Sn,i,. Fire 5ys}ew s 1 T•t1c, APPLICANT NAM C i r\ C�x OFFICE PHONE MAILING ADDRESS (!06- 5`l -j -S /}-v,,:, \�C'5-k- CITY. STATE, ZIP TCxC0'V'4/- CELL PHONE RELATIONSHIP TO PROJECT ��AM FAX NUMBER S ❑ Architect ❑ Tenant ❑ Agent t)( Other p1 b v e.. e- CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER --C,L EXPIRATION DATE / FAX NUMBER 9-` Z3Sa 19-V- pC)00'55"0b 12-131/07 (253 ) - CONTRACT'OR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS S I`-(zT\A 1-5 \3 6 a'r ) I f o 8 COMPANY NAME m,�i. =v.c. APPLICANT MTE (' %Yk Lke-sk,`V, OFFICE PHONE (2S3) MAILING ADDRESS ii oG - CITY, STATE, ZIP qv� zy CELL PHONE RELATIONSHIP TO PROJECT ��AM FAX NUMBER S ❑ Architect ❑ Tenant ❑ Agent t)( Other p1 b v e.. e- (t.S 3) 9at, - 2 3 o NAME pp � PRIMARY PHONE E-MAIL ADDRESS 3o�h 2 e( rpt c( (dS3) 2qq - 2(0$` reii1er Srn, r tsn, NAME Per RCW 19.27.095: Lender information is required (f project value exceeds $5,000 MAILING ADDRESS CITY, STATE, ZIP PHONE EXISTING USE \ �' t" r e i 1 �iAna u 6� n e_ f PROPOSED USE \S - (- e * EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $q A I D U SPRIN]KL :RED BUILDING? i YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? AYES ❑ NO WATER SERVICE PROVIDER ❑ LAKEHAVEN �GHLINE ❑ TACOMA ❑ PRIVATE (WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHIdNE ❑ PRIVATE (SEPTIC) PROJECTAMIL ••• AREA DESCRIPTION r GAS PIPE OUTLETS WOODSTOVES BBQS PROPOSED S . FT. TOTAL S . FT. PROJECTAMIL ••• AREA DESCRIPTION AREAS EXISTING SQ. FT. GAS PIPE OUTLETS WOODSTOVES BBQS PROPOSED S . FT. TOTAL S . FT. BASEMENT FIREPLACE INSERTS HOODS (commercial) COMPRESSORS FIRST RANGES DUCTS GAS LOG SETS SECOND ❑ YES ❑ NO UP/SEPA/SU? ❑ YES THIRD PLATTED LOT? ❑ YES ❑ NO DEMO PERMIT REQUIRED? ADDITIONAL FLOORS (DESCRIBE) ❑ NO DECK (❑ COVERED OR ❑ UNCOVERED?) GARAGE ❑ CARPORT ❑ NUMBER OF FLOORS *�Qernvo rxorosID rornc rarncsoararosr rnr�crnorosrnarw "NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing,fUtures to remain. Value of Mechanical Work (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION) AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES BBQS FANS GAS WATER HEATERS MISC (Describe) BOILERS FIREPLACE INSERTS HOODS (commercial) COMPRESSORS FURNACES RANGES DUCTS GAS LOG SETS REFRIG. SYSTEMS BATHTUBS (or Tub/Shower Combo) DISHWASHERS DRINKING FOUNTAINS ELECTRIC WATER HEATERS HOSE BIBBS LAYS (Bathroom Sinks) RAINWATER SYST SHOWERS SINKS SUMPS URINALS VACUUM BREAKERS WATER CLOSETS (Tollet) WASHING MACHINES MISC (Describe) I cert(fy under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that 1 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, andffiled against the City gfFederal 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 C lM &-� C RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect DATE 9 10 � 7 t Other 10 v o NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR o TENANT IMPROVEMENT BUILDING SHELL ONLY? ❑ YES ❑ NO BASIC PLAN? ❑ YES ❑ NO ZONING DESIGNATION CHANGE OF USE? ❑ YES ❑ NO NEW ADDRESS REQUIRED? ❑ YES ❑ NO UP/SEPA/SU? ❑ YES in NO PLATTED LOT? ❑ YES ❑ NO DEMO PERMIT REQUIRED? ❑ YES ❑ NO Bulletin #100 —January 1, 2007 Page 2 of 4 MandoutsTermit Application