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04-102063crry of ti Federal Way COMMUNITY DEVELOPMENT SERVICES 33530 FIRST WAY SOUTH • PO BOX 9718 FEDERAL WAY, WA 98063-9718 253-6614115• FAX 253-6614129 www. dh/o(Tede rdwa n. mm The follourinq is require PER RCP. i_. MF O E EL PL DE EN FP APPLICATIOJJY 2g' -4- NJ�40 - an incomplete YPlease SITE ADDRESS 3K, 2-0Oj/r✓�f)��% SUITE/UNIT # ASSESSOR'S TAX/PARCEL # _ - LOT SIZE (s� LEGAL DESCRIPTION (e.g, Acme Estates, Lot 1) (Attach sepamfepage jor Ie glhy legal d—ipt—) or TYPE OF PERMIT DING PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM PROJECT DDESCRIPTION (Provide detailed description of work included on this permit onlu) PROJECT NAME (Name of Business or Owner Last Name) C /L13Z,.12y � 114Qz2 PEOPLEINFORMATION PROPERTY NAME PHONE OWNER CONTRACTOR APPLICANT CONTACT LENDER EXISTING USE MAILING ADDRESS CITY, STATE, ZIP COMPANY NA E APPLICANT NAME OFFICE PHONE MAILING ADDRESS CITY, STATE, ZIP CELL PHONE CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER — — — — — — — — — --B L CONTRACTORS REGISTRATION NUMBER (copy o[ card r"ui—d with each application( EXPIRATION DATE COMPANY NAME C - APPLICANT NAME / A, OFFICE PHONE (I'll S-3 ) MAILING ADDRESS CITY, STATE, ZIP CELL PHONE RELATIONSHIP TO PROJECT ❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe) (4kv- U)' S - 23Z FAX NUMBER V5-3 ) k ` v NAM PRIMARY PHONE E-MAIL ADDRESS Per RCW 19.27.095: Lender information is NAME required if project value exceeds $5,000 MAILING ADDRESS CITY, STATE, ZIP EXISTING ASSESSED/APPRAISED VALUE $ SPRINKLERED BUILDING? ❑ YES l' NO WATER SERVICE PROVIDER ❑ LAKEHAVEN SEWER SERVICE PROVIDER ❑ LAKEHAVEN PROPOSED USE 6A/Mg VALUE OF PROPOSED WORK $ FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED? ❑ YES ❑ NO ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) ❑ HIGHLINE ❑ PRIVATE (SEPTIC) PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING S . FT. PROPOSED SQ. FT. TOTAL BASEMENT,, « FANS HOODS (Commercial) WOODSTOVES � � 1 Raw WT% 's FIREPLACE INSERTS RANGES MISC (Describe) SECOND FURNACES GAS WATER HEATERS NEW ADDRESS REQUIRED? ❑ YES 'WNO THIRD GAS PIPE OUTLETS PLATTED LOT? ❑ YES ❑ NO DEMO PERMIT REQUIRED? ❑ YES FOURTH ADDITIONAL FLOORS (DESCRIBE) SHOWERS WATER CLOSETS goikt) MISC (Describe) DECK(COVERED?) SINKS DRINKING FOUNTAINS GARAGE/CARPORT SUMPS RAINWATER SYST p HOW MANY FLOORS? TOTAL. FXISTLFG TOTAPROPOSED L. TOTAL. rMS MG MD PROPOSED "NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. 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 NEW ADDRESS REQUIRED? ❑ YES 'WNO DUCTS GAS PIPE OUTLETS PLATTED LOT? ❑ YES ❑ NO DEMO PERMIT REQUIRED? ❑ YES PLUMBING BATHTUBS (or Tub/Sho Combo) SHOWERS WATER CLOSETS goikt) MISC (Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST p WASHING MACHINES URINALS Z HOSE BIBBS I R / ®G LAVS (Bau,­omSi ks) VACUUM BREAKERS ELECTRIC WATER HEATERS 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 o cers and employees, upon the accuracy of the information supplied to the city as a part of this application. NAME/TITLE --(SIgRaTu rel (l rtLe� RELATIONSHIP TO PROJECT ❑ Owner X Agent Contractor ❑ Architect ❑ DATE S L O T FOR OFFICE USE ONLY ❑ NEW X -ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT BUILDING SHELL ONLY? o YES O BASIC PLAN? o YES "IAO ZONING DESIGNATION CHANGE OF USE? ❑ YES �Rr-N0 NEW ADDRESS REQUIRED? ❑ YES 'WNO U SEPA/SU? ,ofES ❑ NO PLATTED LOT? ❑ YES ❑ NO DEMO PERMIT REQUIRED? ❑ YES ;AO Bulletin #100 — March 30, 2004 Page 2 of 4 k\Handouts — Revised\Permit Application