07-101039 A . circoP len*r~'rf,� t: I
Federal Way RE VEU PF,RIVIIT ' `'? 11.-nom 3
COMMUNITY DEVELOPMEIVT JTH•poBOX9SERVICES
,SF MF CO ME EL PL DE EN
33325'8TM AVENUE SOUTH•PO BOX 9718
FEDERAL WAY,WA 98063-9718 FES 2 8 APPLICATION •
.253-835.2607•FAX 253.835-2609 • ?D
uww.mHuoffcderniway.com '
The following is reQQi4�'���"i�T V WAYincomplete application will not be accepted. Please print legibly(in in777k)or type.
• • •_ • 'f L L7 S PROPERTY INFORMATION
SITE ADDRESS , , f u , —, 1
/. . SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# _L c O .- Cl O_
•
U v LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal desenpfiun)
• ■ PROJECT INFORMATION ...
TYPE OF PERMIT 0 BUILDING
O PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL ❑ ENGINEERING 'AFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
Co.-sip
•
•
PROJECT NAME(Name of Business or Owner Last Name p'
Ot�u' �� 'Lf lrIFCJv3c
III.PEOPLE INFORMATION
•
PROPERTY NAME •
OWNER J y� 0 L '17 4 Air IA)
, 1 }��g � PRIMARY PHONE
MAILING ADDRESS f VtJ /f'3! G s ;- �• . ��-•Q,�T� p" (
���� /� �p CITY,STATE,ZIP f „( C•,'t E-MAIL ADDRESS
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CONTRACTOR COMPANY NAME
,fin✓ P.L AP LICANT/N/��ME g OFFICE PH
ONE
MAILING ADDRESS4� .,gra ++ IP 1-✓' . HOj -' 4 "1'.dO
DO h ,STATE,ZIP 9 Z CELL PHONE !
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER KIN l W ` `0 •0C TC7 7-Z 17,
EXPIRATION DATE FAX NUMBER
/7 .•4
' - /O .9 '6 —c, L
(-) Std =613
COPY of card required CONTRALTO•'S REGISTRATION NUMBER
with
each application 1 - EXPIRATION D'TE E-MAIL ADDRESS
XX L • i
APPLICANT COMPANY NAME c%c r0�
- APPLICANT NA E
o X Leerrt C, g p�� OFFICE PHONE
Mp IN DDRESS F TA ?`3 € '` (2_5s) .a s Ew
'',„,•) C ,STATE,ZIP `
CELL PHONE
RELATIONSHIP TO PROJECT ��� WA 9f CR Z� �
0 Architect 0 Tenant 0 Agent VOther FAX NUMBER
PROJECT NAME NUMBER(2,4c3) /39
CONTACT 174 / ( � PRIMARY PHONE E-MAIL ADDRESS
LENDER NAME
Per RCW 19,27.095:
MAILING ADDRESS Lender information is required if project value exceeds$5,000
CITY,STATE,ZIP PHONE
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',• l^ IR.,' I •(ItX.�.Mf°�( I •, �t "Al ,,/,;DEA .ED BUILDING INFORMATION ,: h
• °, :
EXISTING USE
PROPOSED USE aZ 1'p4r eAvol.r ✓ ( A L
EXISTING ASSESSED/APPRAISED VALUE $
VALUE OF PROPOSED WORK $ 12 f_
SPRIIv'KLERED BUILDING? ��
t, YE'S 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? •�E
WATER SERVICE PROVIDER ❑ " ❑ NC)LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE
0 PRIVATE (SEPTIC)