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05-105023 41111 ARECEIVE - / CI TN OF 0-._ i © l.._ L � Federal way PERMIT SEP 2 V-7 \ COMMUNTIYDEVELOPMENT SERVICES 9 ZOOS SF MF CO ME EL PL DE E FP ) 333258THAVENUE SOUTH 980 b 9OX 718 A P P L I C A TIO /' FEDERAL WAY,WA 98063-9718 7p 253-835-2607•FAX 253435-2609 EDERAL W www.cituoffederalway.com BUILDING DEP / - - The ollowi • is re.aired in ormation-an incom•tete a.•lication will not be acce•ted. Please .rint le.ibl (in in or .e. ■ PROPERTY INFORMATION • ' SITE ADDRESS 1 S SUITE/UNIT# c- j.) IM__________ ASSESSOR'S TAX/PARCEL# e4- q 3 4j -62 - C Q 5 a LOT SIZE(sj) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal desaipnon) ■ PROJECT INFORMATION TYPE OF PERMIT ❑BUILDING 0 PLUMBING 0 MECHANICAL ❑ DEMOLITION 0 ELECTRICAL 0 ENGINEERING . FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) IHS .ct. iq t / r - ,./ nir. f PROJECT NAME(Name of Business or Owner Last Name) L ` < r , rL - A ' ,CAez . ` . .. . .. • PEOPLE INFORMATION PROPERTY NAME ' / PRIMARY NADINE OWNER .S&41M ` '� ) ,%-�YCC4 MAILING ADDRES CITY TATE,ZIP /048 1 ' - 1/1. 1 �/1 q&)a CONTRACTOR COMPANY NAME APPLICANT NAME /j 1Vr� �J LaoOFFICE OyEMAILING ti DRE , ` (q ��/ /� i-_,7--/ /� �- C{[,��'/�(' e�� // CITY.,STA EE,)ZI (�� )/�} //�77�J} CELL P�/ONE 4 CITY OF F DE WAY BUSINESS LICENSE� �/ BER ,�� d g)C to EXPIRATION( of D E !iC+ 1 6)3� ' / ) �: �'-F 42 `, if B L CONTRACTOR'S REGISTTION N JMBER(copy of card required with each application) EXPIRATION DATE - APPLICANT 'COMPANY'-.0)' COOMTPANY NAME APPLICANT NAME OFFICE PHONE I 0/ MAILING ADDRESS �/yt CITY,STATE,ZIP CELL PHONE [ RELATIONSHIP TO PROJECT FAX NUMBER ❑ Architect 0 Tenant 0 Agent 0 Other(Describe) ( ) - CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS Qit I0l Pe2) -91 LENDER :6si. 01Y).�' ;4 :1-1 F •t t �r NAME • MAILING ADDRESS CITY,STATE,ZIP , • • . • ■ DETAILED BUILDING INFORMATION EXISTING USE _ _.:_. _.=_ — �' • '• D USE /, - EXISTING ASSESSED/APPRAISED VALUE $ 7 VALUE OF PROPOSED WORK $ 4,2%t9 SPRINKLERED BUILDING? 0 YES 7 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 7 ❑ NO WATER SERVICE PROVIDER F LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER 4_LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) IP - L i PROJECT FLOOR AREAS -,- • AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ. FT. SQ. FT. BASEMENT FIRST SECOND THIRD FOURTH • ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) ` GARAGE 0 CARPORT 0 NUMBER OF FLOORS EXISTING \ PROPOSED TOTAL {` • ''tea k r, .. 0TALPROPOSeosr l � ,u.er''''', "NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ F TURES. Indicate number of each type of fixture to be installed eloca ,,as part of this project. Do not include existing fixtures to remain. MECHANICAL / \, Value of Mechanical Work $ N AIR HANDLING UNITS EVAPORATIVE COOLERS G LOGS _ REFRIG.SYSTEMS BBQS FANS HOOD mmarei„q 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(roue[) MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS / LAVS(Bathroom Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS t— 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 ant 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. _ 7- NAME/TITLE Lda, / DATE ^�� - - ) (Title) RELATIONSHIP TO P'0 T ❑ O o Agent 0 Co frac , 0 Architect 0 Other s'aI" I ,t.)l f'(i)i 1 liEWW(1);t ` ns7d74"' i,i 2 WO.;WI g leVoT t --.... lID e i, a r:' a*} ,f,� . ... _ _, zM(c P-ires'gP'' .d 5 � f RE ...., ,� ,_ , �. �Gai - . " UA € 3a� 7 7" i. �..:1 �_A ® �`, _. �a 4� 77.7747:1x'°:-.747,14.71 alb III � via ...,..,o; s �'' `7c1 Bulletin#100-January 7,2005 Page 2 of 4 k\Handouts\Permit Application