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07-102482 RECEIVED III MAY 042 _ Federal Way CITY OF FEDERAL WASERMIT SF MF CO ME EL PL DE EN COMMUNITY DEVELOPMENT SERVICES p- a 333258n•AVENl1ESOUIH•P080X9718+UILDINGPLI CATION FEDERAL WAY. X980&?-9718 / / 253-835-2607•FAX 253.835-2609 www.cuuofederalu au.rnm The ollowin! is re• ired ' ormation-an incom•lete a••lication will not be acce•ted. Please •rint le•ibl (in ink)or - • , �y ` IIIA PROPERTY INFORMATION SITE ADDRESS 3 2°t a 1 IEst E-2 N A rugs E R ' J - S. (32tin 17 tZ S SUITE/UNIT# ASSESSOR'S TAX/PARCEL# 1 to 2 % 0 L1- et 0 ( 3 LOT SIZE(sj) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) Uaach separate pogefor lengthy legal description • PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 1St FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detnilpd description of work included on this permit onlu) A o D -D Mix A Outt-L P L,u,L. sin o kl S --rt E_,,,c(sno3C,. Mo 12 s(aye LE_ F t RE_ A LA-0-ft sYs(-E-_M -DEStGk, AO PEP-441r 01JcY aL.e-c- c)`1 0T%&E(tS PROJECT NAME(Name of Business or Owner Last Name) W EY E2 ITR A E U S 6-CL \ eC N CC-are-P-- II 2Ea1T Q.IIIA PEOPLE INFORMATION PROPERTY NAME /� PRIMARY PHONE OWNER \"I G i E e_ H A e(.t,s tG� lro lR P ( 15 3) a 38 - .5`l o Z MAILING ADDRESS Cm,STATE.ZIP 3 3(-6,3 W EY6a mil .(.s EAt (J asl S FaDc SAY \IIA X18 00- CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE C(RE Os Inc. DALET<LElr.3 (2o4 ) .575 - 0311 MAILING ADDRESS CITY.STATE.ZIP CELL PHONE PGR)oY . )85Z8 iuKW,.ttLA `A/A GS1 S, ( ) - CrTY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER - 1 - 0 t - t O 2G (ALI-B L 12 /3i I ' (253) 872 - `7'-/9O CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE t REo [ * 09GKNei 5 / 16 / 09 APPLICANT COMPANY NAME APPLICANT NAMEOFFICE PHONE Ft zE, ( ` To c 7at..E Vi i�t_a✓L.3 ( 206)67.5- 0311 MAILING ADDRESS Crit.STATE.ZIP CELL PHONE 0►Zox 58S-28 -iuw.wio \in 9 8 i ?- ( ) - RELATIONSHIP TO PROJECT /� FAX NUMBER 0 Architect 0 Tenant 0 Agent IS Other(Describe)COI.i'�'.N CTo (Z53) 812 -7596 CONTACT NA.ME PRIMARY PHONE E-MAIL ADDRESS 'DIAL-E.- \J KLE t.LI (20 6 )57,5 -0311 ank\s meCge-0ne..0Re, LENDER Pei RCW 19.27 095 n.Is NAME - '� .*(fProte0 i" <,'"1-.;4"- $5000,, MAILING ADDRESS CITY,STATE.ZIP PHONE ( ) - • DETAILED BUILDING INFORMATION EXISTING USE A t.e.t.a —1--EC t-1 PROPOSED USE s A tti^E EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ t.` 003.O 0 SPRINKLERED BUILDING? XL YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO WATER SERVICE PROVIDER II LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER OL LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) 410 • 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 ❑ CARPORT❑ EXISTING PROPOSED TOTAL TOCALZEIE}'R'IOIP TOTAL PROPOSID er -TOTAL SP NUMBER OF FLOORS •3,;� a " : .� "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 InclrirlP existing fixtures to remain. MECHANICAL Value of Mechanical Work $ AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOODS icommerd i) 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(roset) MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS IAVS(Bathroom sulk.) VACUUM BREAKERS ELECTRIC WATER HEATERS 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 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 officers and employees,upon the accuracy of the information supplied to the city as a part of this application. NAME/TITLE DALF— V 4-E110 ZE.S 16 OC-1,-OC-1,- DATE � r7— 1 — © t (Signature) (Title) RELATIONSHIP TO PROJECT 0 Owner 0 Agent $.Contractor 0 Architect 0 Other a NEW°` t n a ADDITION a A *P4'TIQN (�RE$t�E� hit ( ,ANT IMPROVEMENT 7r � BUILDIQ G SHELL ONL ci YES # NO.; ) rg C n NO ZONINGUESIGNATION' ..kCHANG OF v � is YES o NO, SE2 A SU2 -'' o YES n N0 NEW ADDRESS REgUTRED? a YES v NO, • .. 3�t1P'f � PLATTEL LOT?. YES • IEMO PE i QU IRED? a NO Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application