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05-103035 CRY OF` RECEIVED Federal Way PERMIT - `3 0 3 `� COMMUNITY DEVELOPMENTSERVIC N 2 4 2005 .. i SF MF CO C EL PL DE EIV FP 3332E 8T"RALWESOUTH•PO BOX ppLI CATI O N -- i FEDERAL W,9Y,WA 98063-9718 p 253-835-2607•FAX 253-ti835-2609 0 A / 05.0 5. �,a-«-cifya(jederanoay�TM OF FEDERAL WAY BUILDING DEPT. The following is required information-an i•co plete ap.lication will not be accepted. Please print legibly(in ink)or type. ,.', ►4 PROPERTY INFORMATION SITE ADDRESS 3( (p d1 J-C S f ,_ .5CaSUITE/UNIT# '� ASSESSOR'S TAX/PARCEL# / •C 3 0 0 0 .C. ,e LOT SIZE (sf) p l g 5 LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) /Attach separate page for lengthy legal des r prion) t ;, i ' - I♦:' PROJECT INFORMATION TYPE OF PERMIT >03UILDING ❑ PLUMBING [MECHANICAL ❑ DEMOLITIOV4LECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this permit onllj) .ram convert/ill niq. darA4.ae into a liviii fcae,t . Th." hent o thi poem 41.//1 have two tvlti1lawi uih/re fh,j 4rQ( door us,e to hi. Thi /y/yr/or wall of /hi room c//ll ht, ve aj ter f dovor . ev/ th, hoth tvA/t .rtvoultt Ilk, to III ftall a s/rd/N 6, �.� lar/ dpvr and ail tker any/do ul_ rvi ado(i "ioh I Would like to tvid ,"Ii - 9n1) 16 ' Qr/v,�wa� hl, p'. PROJECT NAME(Name of Business or Owner Last Name) r '/v ( ( Of q r.:, y �► PEOPLE INFORMATION - PROPERTY NAME r+��,,, / PRIMARY^� PHONE OWNER ---0 ,r//r'/rf1Le a/ac/©J (ic3) go - 217 MAILING ADD SS CITY,STATE,ZIP 31619 Ift to/ f f"-jd/rirl LVI , 111,4 9e0Q3 (-co--rnzA—cToZCOMPANY NAME APPLICANT NAME OFFICE PHONE Oc . . , ( ) r MAILING ADDRE S CITY,STATE,ZIP 44��Irr6 � ' -CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER ii 7 1' , r 7 , ��i L' i ) CONTRACTOR'S REGISTRATION NUMBER(copy of• d required Niiwin EXPIRATION DATE / / IA 1111111•111M11.1.1.m7.1,MI/ APPLICANT COMPANY NAMEPPLINTNE MAILING ADDRESS CITY,STATE,ZI , CELL PHONE RELATIONSHIP TO PROJECT ( ) FAX NUMBER ❑ Architect ❑ Tenant ❑Agent ❑ Other(Describe) ( ) _ CONTACT AME E141 11-ee Pa ff�/ol PRIMARY PHONE r/ ( 25'� 9(F/_ E-MAIL ADDRESS 2/74 LENDER Per RCW 19.27.095: Lender information is NAME required if project value exceeds$5,000 0(4)-7,,,,,4 MAILING ADDRESS CITY,STATE,ZIP - ', ,i 1 DETAILED BUUJDING INFORMATION EXISTING USE i e J/ PROPOSED USE R--(73-[ dr'14/ Gt / EXISTING ASSESSED/APPRAISED VALUE $ 1 7 i/ l C t? VALUE OF PROPOSED WORK $ 4 5-0 e. SPRINKLERED BUILDING? 0 YES NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 10 WATER SERVICE PROVIDER ,ILAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER q`�,AKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) / l� �oaLii/fig PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING SQ. FT. PROPOSED SQ. FT. ^TOTAL t BASEMENT a .."f T U 4. 4 p O g' U ! / f �y Q r FIRST ( y� • _ I U -, SECOND _ 4 – THIRD FOURTH • ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) _____ .)..._ GARAGE/CARPORT .I..R D 77__ . Q — HOW MANY FLOORS? TOTAL TiaSTD(G TOTAL PROPOSED TOTAL EO DIG MD PROPOSED "NEW HOMES ONLY" NUMBER OF BEDROOMS IMA D S tS q �p��c t 5. �7�a- .. t . -,-.61:41.4,.1.4-'!'.,; . ...— -Lk4s _ ,4.:.t.;.":.;( .- 4.0s.C .2.Pa x_. �..,i'�siV�►7 _. -`.-_.."ga�? t .f: F. ..4... Indicate number of each type of fixture to be installed or relocated as part of this project. Do riot include existing factures to remain.. MECHANICAL Value of Mechanical Work $U 0 0 O AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOODS(commadaii W OO DSTO V ES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS(or Tub/Shower Combo) -.OWERS TER CLOSETS(roikt) MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES '•LS HOSE BIBBS LAYS(BaavoomSulks) VACUUM BREAKERS LECTRIC WATER HEATERS . C `y' ;vr+ MO f 4.=: . 'V a " •3'iWW/sta+rbitiMC ava1E LOcK: - _ _.- _. - 4 I cenlif under penalty of perjuoy that the information furnished by me is true and correct to the best of my knowledge, and further, that I am authoredby the owner of thelnoove premises to Perform the work for which the permit application is made. I further agree to hold harmless the<City of 'edera ay as to any claim including costs, expenses, and attorneys'fees incurred in the investigation and defense of such clainl,P, which may be ma e by any peron include the undersigned,and filed against the City of Federal Way, but only where such claim arises out of the reliance of the city, i e.uding its officer nd ernpMyees, upon the accuracy of the information supplied to the city as a part of t s application. '- • NAME7TITLE DATE (Signature) (Title) I RELATIONSHIP TO PROJECT XOwner 0 Agent ❑ Conractor 0 Architect 0 Other E ( FOR OFFICE USE ONLY a NEW a ADDITION ❑ALTERATION o REPAIR a TENANT IMPROVEMENT ( BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a YES ❑ NO ZONING DESIGNATION CHANGE OF USE? a YES ❑NO t NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? ❑YES a NO f Bulletin 11100 March 30,2004 – Page 2 of 4 k\Handouts–Rcvised\Pcrmit Application