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06-102820
C ,-, � RECEIVED kc7 Federal Way I PERMIT COAINIINITY 09VEI.OPMENTSERI•' F . VEAVP � o 7 zoo�APPLICATION FEDERAL WAY, WA 98063-9718 253 835 26a7• FAk Yb3- r • 6U9 ,QI m < OF FEDERAL -�WAy { The following is re' ,u UD �it1ARt'ion - an incomplete application will not be SITE ADDRESS - a - * 0 SF RFCo ME EL PL DE EN FP rM e.S� fed. Please mint leoiblu (in ink) or dupe. SUITE/UNIT # r� ASSESSOR'S TAX/PARCEL # 5 5 vL q 0 Q - 6) 1 ©'. I y� q 0003 LOT SIZE (sf i.Ff:Ai, i]F4grRiPTinN tP.n. ArmP F.,ztntP.c� _ i.nt 1) 'L�.�i '�c>: 2) . s2— "i1 i ,x" Arvk s (Attach separale pagejor 0.rrrgthy legal descrlptiaN TYPE OF PERMIT / BUILDING ❑ PLUMBING ❑ MECHANICAL I/ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of Mork included on this permit onlu) ASr•1'1A1r L-rtz4— VP AAF'fth -%k. % d INvbnaA, i H .. i LA P Ui l A,' nG 1 nC. q&--'vua C A V1 . ■J� / 1, I Lam. I±- W ! i!1 ��/ +{ 1` � - PROJECT NAME (Name of Business or Owner Last Name) 6'^ l2 n 0PEOPLE •• • PROPERTY OWNER CONTRACTOR APPLICANT CONTACT LENDER NAME PRIMARY PHONE "GC Two '&':)C r � e,, �s Ll MAILING ADDRESS CITY, STATE, ZIP COMPANY NAME APPLICANT NAME OFFICE PHONE MA;L_,I ((, ,ADD • r fff CITY. STATE ZIP i �¢��7 CELL PHONE CITY OF FEDERN. WAY BUSINESS LI('FNSr NI IMBER 0-. b -B F"IRAITON DATE 12- / 31 /©iCa-, FAX -NU 42S )"0, -617�5 Cz z-1 4 i�- S Q. L C.'ONTf(ACTORS. REGISTRATION NUMBER (copy of card requlred with each application) EXPIRATION 4/19/2"w DATE. NERC-LL�l�[ L'UMI'ANY NAMt: APPLICANT NAME OM. C1; PH E Sew a s AID+` �. { MAILING A13DRF SS CITY, STATE, ZIP CELI. PHONF. RELATIONSHIP TO PROJECT /' y, Tenant Agent 'm Other (AesrriFie) FAX NUMBER ❑ Architect ❑ ❑ NAME PRIMARY PRONE I E-MAILADDRE.SS (4w aq q - 6 chi ,cam Per RCW 19.27.095: Lender iriformation is NAM4 �{ j required {f project value exceeds $5,000 ING DRESS `�. M(A.�L1qQ CITY. S'I'oo�ZIP -6 �a {1IONE 270) 20-z- 3 EXISTING USE r l it {t- t FdAl"►A j _ PROPOSED USE -5�V v` F EXISTING ASSESSED/APPRAISED VALUE $. + i Q•2C)1 iJir0 VALUE OF PROPOSED WORK SPRINKLERED BUILDING? ❑ YES %<NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 00 WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC) PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING S . FT. PROPOSED S . FT. TOTAL S . FT. BASEMENT FIRST i 4-6-7 SECOND THIRD FOURTH ADDITIONAL FLOORS (DESCRIBE) DECK (COVERED?) l 1 0r �l GARAGE ❑ CARPORT NUMBER OF FLOORS EXISTING PRO ru TOTAL S TOTAL EXIBTDVG SP TOTAL PROPOSP.A Sr• TOTAL BY **NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $. Indicate number of each type qffixh.tre to be installed or relocated as part of this project. Do not include existing fixtures to remain. paryR.rasursarsa, Value of Mechanical Work - 8� AIR HANDLING UNITS EVAPORATIVE COOLERS BBQS FANS BOILERS FIREPLACE INSERTS COMPRESSORS FURNACES DUCTS GAS PIPE OUTLETS ar BATHTUBS IorTub/Shower Combo) SHOWERS DISHWASHERS SINKS GAS PIPE OUTLETS SUMPS WASHING MACHINES URINALS LAVS tHxilvomnsiitko VACUUM BREAKERS GAS LOGS HOODS )Conmierciap RANGES GAS WATER HEATERS WATER CLOSETS )Toilet) DRINKING FOUNTAINS RAINWATER SYST HOSE BIBBS ELECTRIC WATER HEATERS REFRIG. SYSTEMS WOODSTOVES MISC (Describe) MISC (Describe) I certify under penalty of perjury that the irformation 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 _ DATE I U (SI�rIT rrl 117 Cl RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent Contractor ElArchitect ❑ Other FOR OFFICE USE ONLY ❑ NEW ❑ ADDITION o ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT BUILDING SHELL ONLY? ❑ YES ❑ NO BASIC PLAN? ❑ YES ❑ NO ZONING DESIGNATION CHANGE OF USE? ❑ YES ❑ NO NEW ADDRESS REQUIRED? ❑ YES ❑ NO UP/SEPA/SU? ❑ YES o NO PLATTED LOT? ❑ YES ❑ NO DEMO PERMIT REQUIRED? ❑ YES ❑ NO Bulletin #100 —January 1, 2006 Page 2 of 4 k\Handouts\Permit Application