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06-103810 �EG�I� ..�.� tin oF v� — � D� �� � Federal Way 12oos pERMIT COMMUMTY DEVEIAPMENT SERVICES A�G �- SF MF CO ME EL PL DE EN FP 333258TMAVEMlESOUfH.�BOX9,�8 ��LICATION FEDERALWAY,WA 98063-9718 �TY OF ��p 253-835-2607•FAX253-835-2609C B���p��yG T. / / miuu�.cit�offederalu;n�.com The ollowin is re uired i ormation-an incom lete a lication will not be acce ted. Please rint le ibl (in ink)or . � . � . � aiTE nn�xEss �1�SC� �i����' �-�,,� � ���r�:�l ��J��� (JJ� f�'JJJ suiTE�uxiT a 1 ���. ASSESSOR'S TAX/PARCEL# Q �� c� � o �� - � � �Cr LOT SIZE(s,� �E� C� I � LEGAL DESCRIPTION (e.g.Acme Estates,Lot I) ������'�C%`���� (Attnch separate page for lengthy legal descrfptioN ' • • ' • TYPE OF PERNIIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING �I FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Prouide detailed description of work included on this permit onlu) ` h.�J tn:�t�II �� c:�-�r.�:ln,C.� {r�-�2.r�✓,C.' fo f�✓�I� n. ,. PROJECT NAME(Name of Business or Owner Last Name) V L'4 �nc.,� �<'),�.r��",p��',�v C'+�� ' �r�r�2.�ix-� VV��.� • • • � • _ PROPERTY NAME PRIMARY PHONE OwivER �e,�`���c�,�1" ���urs�:��n^��,�t .L�� . ��s'i� ) v�-l�l - �jUr.�c� MAILING ADDRESS CI1Y,STATE,ZIP ��n l� 1..5Frn/'� ����,� (-..�'�� /-)...,�f .��J�,r,�.�-��� �/� jlc.�,�U,_5 CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE �' n �,,� �� L..�i7� :� ��';�P_f )C�,'�P_J ,�!':L .3t�'-�/� %�:7�.v,I�n, �_,�y 4x����)L� i`� - (�C7`1 r-i MAILING DRESS CI1Y,STATE,ZIP CELL PHONE i-'o �-,� �"�"��`a �--v�-a�r_:.1 U.���. lJ�;=} ��I�:;> ( ) - � CPIY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPI ON DATE FAX NUMBER _� i � ' � " � o� � � - / '-� U �, �! _B L 1 0� �>j :_ ? �).� ��i y.3 ) 1��j?�' -7 J<)� CONIRACTOR'S REGISIRAITON NUMBER(copy of cazd required with each applicatlon) EXPIRAITON DATE � � o �L �� �. � � 3 � C� � C/ � ;=� � �c>��;( APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE �7�r('I^,�,;� �7.> ���f:'1"�d_G."�r�� � � - MAILING ADDRESS CI1Y,STATE,ZIP CELL PHONE � � - RELA'IYONSHIP 1'O PROJECT FAX NUMBER ❑ Architect ❑ Tenant ❑Agent ❑ Other(Describe) ( � - CONTACT NAME , PRIMARY PHONE E-MAIL ADDRESS �i�.✓ �' `� o a �«�rzn��,r�, (����) �i`- - G��i� LENDER NnME � _ , i��r ��- ,��,�,��1 G-.,�f, MAILING ADDRESS CI1Y,STATE,ZIP PHONE �a�.�l c_c.ntvf,= �'"t.rlt � Jt' f�� L�S.> �1� e,lz,� (--�'1 %�,�.,�� ( ) - � � : � • • • EXISTING USE PROPOSED USE , '�' �lu d.�a EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $� SPRINKLERED BUII.DING? �YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/RE9UIRED? ❑ YES ❑ NO WATER SERVICE PROVIDER �LAKEHAVEN ❑ HIGFII.INE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER LAKEHAVEN ❑ ffiGHLINE ❑ PRIVATE(SEPTIC) � � • • •• • AREA DESCRIPTION EXISTING PROPOSED TOTAL S .FT. S .FT. S .FT. BASEMENT FIRST SECOND THIRD FOURTH ADDITIONAL FIAORS(DESCRIBE) DECK(COVERED?) GARAGE ❑ CARPORT❑ ausrnvc raoeoaen rar,w � NUMBER OF FLOORS �� ��t i �� 3 � °� �3+ ���n'"�� '�t�� � �,s��E��s'��� �. - r� �� `�� ' �,�;t �ma rm � �� �"' "'NEW HOMES ONLY'` NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ Indicate number of each type of fixture to be instailed or relocated as part of this profect. Do not inciude existing fixtures to remain. MECHANICAL Vaiue of Mechanical Work $ AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOODS(commemtaq WOODSTOVES BOILERS FIREPLACE INSERT'S RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUlY�ING BATI�TUBS�or1Lb/ShowerCombo) SHOWERS WATER CLOSETS(roneq MISC(DeSCdbe) DISHWASHERS SINKS DRINffiNG FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINAIS HOSE BIBBS LAVS(Bathroom Stnks) VACUUM BREAKERS ELECTRIC WATER HEATERS � • I certi,fy under penalty o,f per,jury that the ir}formarion furnished by me is true and correct to the best of my knou�[edge, and further, that I am authortzed by the o�uner of the above premises to perform the tuork for �uhich 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 tncurred in the investigation and defense of such claim),u�hich may be made by any person,including the undersigned,and filed against the City of Federa!Way,but only where such claim artses out o,f the reliance o the city,tncluding its o,�cers and employees,upon the accuracy oj the ir4formation supplied to the city as a part of this application. /;� � ,�1 .-�. > NAME/TITLE `'�—-_ '�1 c.c,�.-} �/ 1�,.n.,,:<�_/ DATE �f�,L�V (Signature) ('1'itle) RELATIONSHIP TO PROJECT ❑ Owner ❑ P,gent � Contractor ❑ Architect ❑ Other �. � � o �H�� s� . � 1,., �- � `�`'Y� Cf������ ,G�';�' L� h5 a�t �,� ���' �z i � ��`���� x��`�'���i � ,�r � C����sr,."� �i�..�;��,�:,��` �'£ � r3��r�' C ��" r��`�`,�'�. x�,..�.�t�,� i �i��';k7�� �„��. �,gz���eA�.i � �`�'^g�p� �"�..�'� t"�� ,�. � �'.:1. "n�} � +_x.t�,� } �;����:w r '� �r'���`�� r V �+k a"�, ° � ' _ ' ��� ��r� ,r '�.'��' '�4 '�� -� '�i < • �- a �` - e :,i� � g ��.� � '� s� L � �- _ _ '��7.-'�"Y.v..a'.�. ���7 -;�q�,u p5� .��,� �€! a {�,. r �*x u i�-��"�k�s ,-�h��$6`'4-ti}� � � � � �.��'—�37 W V:� ��� 1 � ';��:�y � �, ,�r ' �^,"'`�� ��������4"�N�t�(��R�'��•. .t w�. � � G i ,., ...:. . @ . .. . ,.e a . :� -. . t,. .�'��i,� Bulletin#100-January 1,2006 Page 2 of 4 k�I-Iandouts�Pernut Application