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04-102173 RECEIVED BY UOMMUNI7Y DEVELOPMENT SERVICES COMMUNITY DEVELOPMENT D ENT P 33530 FIRST WAY SOUTH•PO BOX 9778 `FederalP RM IT*APPLICATION FEDERAL WAY,WA 98063-9778 Way 2536614115•FAX25altrom 29 J U N /.2- -76.11° lrnuw. y�©.rlcrnlmap.mm C) - 1 C7 2 1 .i7 3_ C) C) To: /Z- 7 Y For Office Use Only FW File Number: _ / / The ollowin• is re.uired in ormation-an incom.fete a••lication will not be acce•ted. Please •rint Ie•ibi (in ink)or •e. . ■ PROPERTY INFORMATION SITE ADDRESS: 3 Log 3 Po- FI(uuc, S. F— ,,..,...tiIA:A A . el, b SUITE/APT# I I ASSESSOR'S TAX/PARCEL#: Q ./ ,2 I O i1 - f _ 6, SQUARE FOOTAGE OF LOT: LEGAL DESCRIPTION (e.g.:Acme Estates, Lot 1) (Attach separate page for lengthy legal description) ■ PROJECT INFORMATION TYPE OF PERMIT(This application): 0 BUILDING ❑ PLUMBING ❑ MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING4FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this permit only): A _ — ' / to . . v' kV c./ O•)a-Cf.4 d" 1 . PROJECT NAME(Name of Business/Owner Last Name): Ci)„.,O p t 5, Di ,T,J.,y, 1 ■ PEOPLE INFORMATION PROPERTY NAME: PRIMARY PHONE: OWNER NG..J rtvsi {Ltt„ ( ) - MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP CONTRACTOR NAME ( r- COMPANYt OFFICE PHONE: Pc&c i\\i F — (),Dated teJ(.`C , VkV. 1Jaccak ( p/SS) Tab -02a.70 MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP CELL PHONE: `>O'7 'c rA.,.�- IF. lc Lo vv ( f(`(' AL( ( ) - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: EXPIRATION DATE: . FAX NUMBER: Ii-1L-4aL5� kI-oc�� )a /31 /o ( a3 )fan - ( lS CONTRACTOR'S REGISTRATION NUMBER: A /7 � EXPIRATION DATE:/ (copy of card required with each application) P I T (S. z F P (i GL C T IC / `-- /67- LENDER NAME: DAYTIME PHONE: (If Proposed value>=5,000( ( ) - MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP APPLICANT: NAME: CO/� {{ �y�•A PANY OFFICE PHONE: MAILING ADDRESS(STREET ADDRESS): `OJ �1� /STATE,ZIP �-P.-0�c b , " EVENING) P�a L. as 90 NE: .2,0-? Ib,a^ fg- E-, hte, L,.-1v49tYOZ f (GL-3) 9 10 -aaf0 RELATIONSHIP TO PROJECT: FAX NUMBER: 0 Architect 0 Tenant A-Other(Describe): S. (*i Litcc a (-is-3 ) 5a?, - 6<11) CONTACT PERSON FOR THIS PROJECT: 0 Property Owner TiL Contractor 0 Applicant E-MAIL ADDR S: UArt 6 a a+,.af- y, ,(Al4- ■ DETAILED BUILDING INFORMATION EXISTING USE: PROPOSED USE: EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $ 3�CO �� . SPRINKLERED BUILDING? A YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: ❑ YES 0 NO WATER SERVICE PROVIDER o LAKEHAVEN 0 HIGHLINE o TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE o PRIVATE(SEPTIC) ' ■ PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING SQ. Ft. PRO' D SQ.FT. TOTAL L BASEMENT FIRST3 eco sl 4 .�-. SECOND 1 1 t THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE/CARPORT HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED **NEW HOMES ONLY** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ ■ FIXTURES Indicate number of each type of fixture that is 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) __COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS crone) MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYS WASHING MACHINES URINALS HOSE BIBBS i LAVS(Bathroomsu, 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: Lf,,,,,ii.,._ / p, r� (%vtl,,_6./A(ts'�. DATE: (-/ lb t( (Signature) (Title) l RELATIONSHIP TO PROJECT: ❑ Property Owner a Applicant 4 Contractor 0 Architect 0 FOR OFFICE USE ONLY: 1 o NEW o ADDITION ❑ALTERATION o REPAIR ❑TENANT IMPROVEMENT BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? ❑YES a NO ZONING DESIGNATION: CHANGE OF USE? o YES o NO NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES a NO PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES a NO ( Bulletin :illi „a::;i, 1. ;.:U.i Page 2