07-101783.SUBMI'i i ED � �o t 2� 3
CITY or
Federal Way APR U 4 2007 PERMIT SF MF COME EL PL DE EN FP
COMIYUHITYA AY, WA"
SERVICES L I C AT I O N
=25 SM AVEKVJK SOUTH • PO BOX WIS
FM35-LIYA}',4X ,,=Y �F FEDE
ss�'HEW. V4 00asp BUILDING 'uu+ Pfi Y11WrlV� �
The following is — an irtcv le �ted. Pterxse print % ibl ire tak or
SITE ADDRESS ;�4jj D,Z
VIV `� SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # 15 2 61 5 '" 0 O ® LOT SIZE (sf)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach porde p.ge f� -.gthyleg.Zd--iphonJ
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING IRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
,.ALv.t fj i= ? A ('2., S 5TEa✓1 i:--'z- A Ct-�SitiJ ;aWZ
PROJECT NAME (Name of Business or Owner Last Name) J 10 "H �' 1 w L r
PROPERTY
NAME PRIMARY PHONE
OWNER "r(Z(Lgol_-6i06 LIP l/I-)
V�c.1 1c- WA e�eCA-
7
CONTRACTOR [ unvnnr Rr r.
F0c)-r&C000 �5, i kk_ U,rzet=, r�()r��
MAMIN 3 ADDRESS CITY, STATE, ZIP
Z�'Z'7S> MAPLC v�� I��K :�E =� pAPL VA-i,LC-q,
CM OF FF.DERAI. WAY 13I3$MMU LICENSE NUMBER EXPIRATION DATE
CONTFACTOWS RWISn?Anuj4 NUMBER jeopy of card required wStA each appllexetlooj
AL[�_F l Psi 4-1 PI
(4z�) 4:3Z -44D I
( Z0L) �54G - 1 Z64
L+XPIRATIDN DATE
►Z / 31 /O 7
APPLICANT
COMPANY NAME
APPIdCAHT HAMS O[+I+ICE PHONE
( ) -
L • r �r � a
MAILING ADDRESS
CITY, STATE, ZIP CELL PHONE
( I
RMATIONSHIPTO PROJECT
FAX NUPAf3FR
❑ Architect ❑ Tenant ❑ Agent ❑ Other
(Describe) ( )
CONTACT
NAME
Hope-&fr
PFWARY PHONE F.MAn' 4ATaR
42S ¢3Z - 44v i 3 i 70# f e relt
'/JgcCa
LENDER
Per SCW 19.27.095: Lender Wormation is
NAME
required (%project value exceeds $5,000
..rn.. tner: annvr.-¢.r•
CT'CY, 5'171TE, ZIP
EXISTING USE
EXISTING ASSESSED/APPRAISED VALUE
SPRINKLERED BUILDING? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN
SKWER SERVICE PROVIDER ❑ LAKEHAVEN
PROPOSED USE
VALUE OF PROPOSED WORK $� G��'2 UU .-
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ HIGHLINE ❑ PRIVATE (SEMIC)
Z(02 3 3
Value of Mechanical Work
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS (orT b/Shower combo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS (Flelhrenm ShLk.)
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
;ACUUM
PIPE OU XrS
a • RS
S
MPS
NKS
BREAKERS
GAS LOGS REFRIG. SYSTEMS
HOODS (com—dal) WOODSTOVES
RANGES MISC (Describe)
GAS WATER HEATERS
WATER CLOSETS (Tou.q MISC (Describe)
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
I certM underpenatty *fpe JwV that the irjormaticn furnished by me is true and correct to the best of my knowtedge, and further, that]
am authorised 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 costa, expanxea, and attorneys' jeea incurred in the investigation and dq�ense of
such clahn), which Haar/ be made by any person, including the undersigned, and filed against the City of Foderal Wayp but onty where such claim
arises out of the retiance of the city, including its officers and employees, upon the accuracy of the irWformation supplied to the city as a part of
this application.
NAME/TITLE / .V [L6 -P(7��� DATE
[Signe[urc] (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent 'Contractor ❑ Architect ❑ 001cr_
FOR OFFICE USE ONLY
❑ NEW ❑ ADDITION
BUILDING SHELL ONLY?
ZONING DESIGNATION
NEW ADDRESS REQUIRED?
PLATTED LOT?
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
❑ YES ❑ NO
BASIC PLAN?
❑ YES
❑ NO
CHANGE OF USE?
❑ YES
❑ NO
❑ YES ❑ NO
UP/S WA/SU?
❑ YES
❑ NO
❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
Bulletin #100 — August 19, 2004 Page 2 of 4 k\Iandouts\Permit Application