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04-101413 �V 3.... COMMUNI7Y DEVELOPMENT SERVICES 33530�IRST WAY SOU7}/•pp gpX 9718 cm oF� � � FEDERAL WAY,WA 98063-9718 Federa�way PERMIT APPLICAT�ON , 253�6'�'�U m��.n5��6,.�,�29 Poc OQic<Uae Only: � � _ � _ /'�.,,,,� TD: FW File Number: �� The ollowin is re uired in ormation-an incom iete a iicatiort will not be acce ted. Please rint Ie ibZ (in inkf or e. - • • • t � - � • SITE ADDRESS: �yh J S ��l � �L , �Pi�d��v"�� 1�'� �/4- SUITE/APT# —i�= ASSESSOR'S TAX/PARCEL#: � 9 �� - �� V SQUARE FOOTAGE OF LOT: T LEGAL DESCRIPTION (e.g.:Acme Estafes, Lot 1 J (Altach separafe page for lengfhy(ega(descnptionJ - � y 1 � - � � • TYPE OF PERMIT(This applicatioa): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING t�IRE PREVENTION SYSTEM 'k � PROJECT DESCRIPTION(Provide detailed descripiion of work included on this pernut onlul: � Ne�,J � �' p c " Ye� � — F ' �� — c� j � d� PROJECT NAME(Name of Business/Owner Last Nam�: L s�=U� �� ,C s r ' • • 1 • - • PROPERTY NAME: .. ` PRIMARY PHONE: owxEiz; � r v�`( ( ) �a� � MAILING ADDRESS(S�2E T ADDRESS;�: qTY,STATE,ZIP (� � � CON�RACTOR NAME COMPANY ' OFFI�PHONE: - � � �� -� �+�+�—��'°4 �tJC INee.r� 6lrc t2 1 MAILING AD S(STREET ADDRESS;): CITY,STA�� ELL PHONE:� -�� w`�' 3�L 0�- vCs St� �Q� 1 C[TY OF FEDERqL WAY BUSINESS LICENSE NU BER: EXPI TION ATE: . FAX NUMBER: ; �.o_ o o_1 0 � �o �`oo _ , �.. !z,3� %y c�s3�g�� -o� �q � CONTRACTORS REGISTRATION NUMBER: XPIRATION DATE: k (copy of card required with each applicatioa)� � � � � �� 3 � � ILENDER N�M�' DAYTIME PHONE: i /�� I (I(Pcopos<d Vdue>f5.000) I v_ _ ( � _ � MAILING ADDRESS(ST ET ADDRE S;�: CITY,STATE,ZIP APPLICANT: NAME� � � Cp�PANY�� FFICE P�ONE: 1 � �i a l MAILING ADDRESS(STREET ADD ESS�: CITY,STATE,ZIP EVENING PHONE: � �� t2n� �2T - D S� ELATIONSHIPTO PR ECT: ) PAX NUMBER: ❑ Architect ❑ Tenant ❑ Otlter (DescribeJ � � - CONTACT PERSON FOR THIS PROJECT: ❑ Property Owner ❑ Contractor ❑ Applicant E-MAIL ADDRESS: � • 1 � : 1 � 1 1 • - • EXISTING USE: C PROPOSED USE: EXISTING ASSESSED/APP SED VALUE $ VALUE OF PROPOSED WORK: $ �' ��`� SPRINKLERED BUII,DING? ❑ YES �IO FIRE SUPPFtESSION SYSTEM PROPOSED/REQUIRED?: � o NO _.,ti WATER SERVICE PROVIDER [�LAI{EHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER �LAKEHAVEN ❑ FIIGHLINE ❑ PRIVATE(SEPTIC)