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06-100941 REGE D It ; 15 �,.�� 416 - 700c, V / Federall Way FEB 2 8 2006 PERMIT SF F CO ME EL PL DE EN FP • C M UM7Y DEV1LO„�Nr SERVES 333250PO 9, oFFED of PPLI CATI ON �_ 253435-2607.FAX253-135-2603BU1LDING wwr.cituoffecteratwwuoom The olio • is , ired in ormation-an into •fete a• •lication will not be acce•ted. Please •rint legibly n or 1 • PROPERTYGilaINFORMATION �+ SITE ADDRESS 362.37 1/71.•s--_,q A- �tJe.rza ' /' ! C(..)01/4 • ` to g3 SUITE/UNIT# ASSESSOR'S TAX/PARCEL# 3 3 l 8, ©- / O L 0-�O. LOT SIZE(sf) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) /30. /2 x r57 X 5:22 x /20. /5 IC 70 014,401 - r 4, d`I i 1ortadtsePt.ng eP -+aewf legal desaiptioni s x Ar'c L fv g(60,�c- ■ PROJECT INFORMATION TYPE OF PERMIT BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM PROJECT D x CRIPTION(Provide detailed description o work included on this permit only) ,80 i-- 01 in, Ce, O i%c. /.2 •s x ,2.2 / az' e t5,/ t,)4 74hc /1-iUsc I , PROJECT NAME(Name of Business or Owner Last Name) ?4e-..41 • PEOPLE INFORMATION PROPERTY PRIMARY PHON; OWNER NAME CL:.wes ( ) /' '( �Gcs� 8 MAILING ADDRESS CITY,STATS,ZIP 002 3 F _.Z/°/. so. Pede/'ct L-af Wa. l q cR'c 3 CONTRACTOR COMPANY NAME APPLICANT NAME - OFFICE PHONE aZ. ( MAILING CITY,STATE,ZIP CELL PHONE ( ) - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER • / / ( ) - - - -B L CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each appleaUon) EXPIRATION DATE I / APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE MA LNG ADDRESS CITY,STATE,ZIP - CELL PHONE ( ) RELATIONSHIP TO PROJECT FAX NUMBER 0 Architect 0 Tenant o Agent 0 Other(Describe) ( ) - CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS ( .) - LENDER NAME N/4 MAILING ADDRESS CITY,STATE,ZIP PHONE tt ( / - ■ DETAILED BUILDING INFORMATION EXISTING USE _hideidil l i — SP PROPOSED USE Aa / /. -' - 5F EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ ee9e SPRINKLERED BUILDING? 0 YES )1(NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES KNO WATER SERVICE PROVIDER "LAKEHAVEN 0 HIGHLINE o TACOMA ,{ a PRIVATE(WELL) SEWER SERVICE PROVIDER .AKEHAVEN 0 HIGHLINE o PRIVATE(SEPTIC) o S PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST S THIRD ' FOURTH • ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) Not covex-c44 GARAGE 0 CARPORT 0 'DORM- NUMBER OF FLOORS rearosroTOT� **NEW HOMES ONLY"' NUMBER OF BEDROOMS \ ESTIMATED SELLING PRICE $ , FIXTURES Indicate number of each type of fixture to be installed or relo v4ed as part of this project. Do not include existing fixtures to in. MECHANICAL Value of Mechanical Work $ \\ AIR HANDLING UNITS EVAPORATIVE COOLERS G-A`1QG\S REFRIG.SYSTEMS BBQS FANS HOODS(Com�erci q WOODSTOVES BOILERS FIREPLACE INSERTS RANGES :",.� MISC(Describe) COMPRESSORS • FURNACES GAS WATER HEATE) DUCTS GAS PIPE OUTLETS PLUMBING - BATHTUBS(o*Tub/Shower Combo) SHOWERS WATER CLOSETS Rae) , (Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE O SUMPS RAINWATER SYST WAg GHES URINALS HOSE BIBBS • • LAVS(Bathroom saki, 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 authorised 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 W••. as to any claim(including costs, expenses, and attorneys'fees incurred in the investigation and defense of such claim),which may be ma• jby tiny person,including the undersigned,and filed against the City of Federal Way,but only where such claim arises out of the reliance oft r city,including its officers and employees,upon the accuracy of the information supplied to the city as a part of this application.NAME/TITLE �,� .•/-'4�e�y/�� I DATE 2—.2 —06 (Sigature) (Title) RELATIONSHIP • •ROJECT a Owner a Agent 0 Contractor 0 Architect 0 Other • Bulletin#100—January I,2006 Page 2 of 4 k\Handouts\Permit Application