06-100028` pECEIVED
Federal ; �,' N ` � 2006
Way PRRMIPT'
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333258TMAVfiM/fistWfff.PO�xJfiY OF FEDELICATIO N
FfiDfiRAt WAY, WA 98063 -9778
253- 835 -2607• FAX 453 -835 -2609 B U II.p�NG
tuwtu citvoffetieralwa com
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accepted. Please print legibly (in inkl or tune.
SITE ADDRESS I+ 0 j S. 32_1-4,,L- S `T
SUITE /UNIT #
ASSESSOR'S TAX /PARCEL # _,57 d 0 4�q _ ` // a3 LOT SIZE (s�
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) 5 t F Cd �✓� L-� �7 2—
(Attech —Wmft P-Mta kgW d- mipef -V
TlPE pF PNRMIT
PVJQJMT DMRIPTION (F
A0
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❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ Fi#B P VEN'1`ION SYSTEM
detailed description of wor�k / included on
PROOBCT NAME (Name of Business or Owner Last Name) ������C� / � / /CJ/
• •
PROPERTY
i' w"R
3
#,
NAME L PRIMARY PHONE
t /� I�G (� (-425T b'- 3310
MAILING 17-3 /vE Z" ID 2- �ITYR STAT
w smri W w eL b i) S 3
COMPANY NAME
Jjl/f?C[) ri/C f:��Yfi'�2e_
APPLICANT NAME
F2
OFFICE PHONE
(2S3) �j -Sz4,D
MAILING ADDRESS CITY, STATE, ZIP
$o
CELL PHONE
( )
A-711
CITY OF FEDE WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
9 -13 Z / 31 / ZOC)6
FAX NUMBER
(3!0) 9q5 - 7-714<7
_ _ L
CONTRACTORS REGISTRATION NUMBER (apF of card ra jairei wlth •teh applieatioa) EXPIRATION DATE
COMP NY NAME
APPLICANT NAME
OFFICE PHONE
( )
M LM ADDRESS
_
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect o Tenant ❑ Agent o Other(Describe)
( ) _
AREA DESCRIPTION EXISTING PROPOSED TOTAL
S!2. FT. F S . FT. SQ. FT
ISECOND I 4
THIRD I
ADDITIONAL FLOORS
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS dJ°s UG PROPOSED
"NEW HOMES ONLY" NUMBER OF BEDROOMS
s
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
AMMMAL 0' d
Value of Mecltanioal Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS
BBQS FANS
BOILERS FIREPLACE INSERTS
COMPRESSORS FURNACES
DUCTS GAS PIPE OUTLETS
BATHTUBS (or7Lb /Shoe rcombo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS pathroomsiolm)
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
REFRIG. SYSTEMS
HOODS (commereiaq
WOODSTOVES
RANGES
MISC (Describe)
OAS WATER HEATERS
s!1,,,
"��
/4h ✓1 4 c ull fA-
WATER CLOSETS (roneq
MISC (Describe)
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
I cert(fy under penalty of perfury that the igormation 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 Inforinatton supplied to the city as a part of
this application.
XO-WTITLF, � / fI/.3 • DATE / ?1_7 1�0
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent Contractor ❑ Architect ❑ Other
Bulletin #100 — January 7, 2005
Page 2 of 4
k\Handouts\Permit Application