06-100984 RECEl• •
anoF BAR 0 2 2006 b & - 6 0 g` cf
• Federal Way PERMIT
33 25 A ENUE oorMME o aoz9 OF FEDEr"�'I WA E SF M' CO E EL PL DE EN FP
FEDERAL WAY,WA 98063-9718 3UUILDIN(( APPLICATION
253-835-2607•FAX 253-835.2609 6€/a
www.atyotjedemhaay.corn '_ /
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The following is required information-an incom.lete a••lication will not be accepted. Please •tint legibi in in or • .
// I PROPERTY INFORMATION •
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SITE ADDRESS 5a) SCUT 3 3 Cc 11. C-icg1a!T. SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# ! 2 b 5 °.° - 6 Ora U -
- LOT SIZE(sj) (9-i', ¢59
LEGAL DESCRIPTION(e.g. Arme Estates,Lot 1) F-c'T 2 6F- WgST- C/3)44/0(-)--1 /,afaF v)\/(51 o,v I
(Attach separate page for lengthy legal descnplon)
PROJECT INFORMATION
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TYPE OF PERMIT /[ BUILDING ❑ PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
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1 ,is_yPROJECT NAME(Name of Business or Owner Last Name) C L),S ?o ; l
. , ,,., • PEOPLE INFORMATION . .. .
PROPERTY NAME p PRIMARY PHONE
OWNER --t141--EE t r( S( 1C714 __(--L ( fzcl 7115-- 4:55-1"
MAILING ADDRESS CITY,STATE,ZIP
CONTRACTOR COMPANY NAMEAPPLICANT NAME
OFFICE PHONE
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MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
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CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
B L / / ( )
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
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APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
K )4 0\1C_at.O A - — Mtc i iAa\Ic-A^-W (0.G3) -S611- -1�4Z
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
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RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑ Tenant 0 Agent 0 Other(Describe) ( ) -
i
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
( ) -
LENDER *--401 :) r . r< ( 04a'- r NAME
2
I MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
■ 'DETAILED BUILDING INFORMATION 7 , r;
EXISTING USE UA-C/Xi•1'T cQ� PROPOSED USE 6FftCKCS)
F EXISTING ASSESSED/APPRAISED VALUE $ V ) 5) q'`C' VALUE OF PROPOSED WORK $ 2- I .- 67-7 4
SPRINKLERED BUILDING? 0 YES td_NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES A NO
WATER SERVICE PROVIDER 7AKEHAVEN 0 HIGHLINE 0 TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER pLAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
• •
PROJECT FLOOR AREAS ."
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ. FT. SQ.FT.
BASEMENT
FIRST "33 '75 3 3-j
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
NUMBER OF FLOORS EXI T010 PROPOSED TOTAL ...a C e +:° a:f wr, ''fir p x )
**NEW HOMES ONLY** NUMBER OF BEDROOMS 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.
MECHAHICAL L_6 (L 1'.i 0
Value of Mechanical Work $ 1 f
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/Showercombol SHOWERS WATER CLOSETS irolleq MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Battvoomsink.) VACUUM BREAKERS ELECTRIC WATER HEATERS
4 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 J
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 arty 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 th/ity, including its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application. //
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NAME/TITLE (Signature � �" �kT DATE
RELATIONSHIP TO PROJECT D Owner 0 Agent 0 Contractor�chitect 0 Other
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