07-101851RECEI D h
CITY OF
Federal INaY APR 0 6 2001
C(7Ef''1' AEf'FiLUPhTF.NTSERVICES PERMIT
41 �' 'r
321%11'ASkNU&SUViH•YI]& r lj
M'835-2 WAY. X 38Qg3.fl7° '' 14I�' F DE �� SF 1VIF CoFEI&RdL ME EL PL DE F
?53.93g-26GT fihX 253-H35-JGU9 � V ILDI N1 ��� � � T pp
mi�rl�i3r'E^ Srlr .rr�rn �'r1
The following is required i /
rtformation - an incomplete application will not be accepted. Please print legibly (in ink or t
' ype.
SITE ADDRESS -•. 2JU
ASSESSOR'S TAX/PARCEL # lle
• r - /UNIT #
L9 �—
LESUITEGAL DESCRIPTION (e.g• Acme Estates, Lot 1) LOT SIZE (sfi
Wlach sepa�atepagef r 1-9thg legal descr(plo -5 • `� L� �1
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
PROJECT DESCRIPTIONDEMOLITION ❑ ELECTRICAL
(Provide detailed description o ENGINEERING XFIRE PREVENTION SYSTEM
I work included on this pe_ ram)
PROJECT NAME (Name of Bum or Owner Lase
COl'y o r r �, d required
wlf r, �•�,rh npp�cetlon
11-7
• /n A
PROPOSED TOTAL
F
S FTrS . FT.AREA DESCRIPTION Sg.
SASI;MENT
FIRST
SECOND
THIRD
ADDiTiONAL FLOORS (DESCRIBE)
DECK(❑ COVERED OR ❑ LINCOVEI�ED?1
GAPAGI: ❑ CARPORT TOTAL SP
'FGiAL pagff.VR TOTAL PFOP�W �
6X3'BYS{M11
NUMBER OF FLOORS
ESTIMATED SELLING PRIG $
**NEW HOMES ONLY**
NUMBER OF BEDROOMS
uctures to remain.
lure to be installed or relocated as part of this project. Do not include existing f
Indicate number of each type o ffIx
(yCFIANIC1iL �l���� fiC pY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
Value of Mechanical Work $ pIPE OUTLETS , WOODSTOVES
EVAi'O V.
. COOLERS _ k � MISC csatib .
AIR HANDLING UNITS GAS WATER HEATERS �, Y, i S� e
FANS /T�
BBQS EEE FIREPLACE INSI: HGODS (commercial)
BOILERS RANGES
FURNACES
COMPRESSORS �— GAS LOG Si;' REFRIG. SYSTEMS
DUCTS
MISC (Describe)
PLUMBING g (n�mroom Sinks)
BATHTUBS (orT.b/shower Combo) WAFER SYST VACUUM SR l
DISHWASHERS WATER CLOSETS
DRINKING FOUNTAINS SHOWERS
WASHING MACHI
SIN
ELECTRIC WATER HEATERS SUMPS
HOSE BIBBS
knowledge -)Est of my and further. that I
the injarmation furnished by me is true and correct to theoration is made. urther agree to hold
I certify under penalty of Peru p the work for which the permit app
the owner of ue premises to perform erases and attorneys -fees incurred In the inuestfgation and defense o
am authorized by Federal of • to any claim finciudtng roses• p Federal Way, but only where such claim
harmless the City of , the undersigned- and filed against the thety aor ration supplied to the city as a part of
such claim), which may b dSie 9y any peon, incffi ier on the accuracy of r11
arises out of the reliance tfi city, including l arers and employees. up
this application.
NAME/TITLE fnt(cl
Contractor ❑ Architect ❑ Other
-vv &nnn-m HIP TO PROJECT ❑ Owner Agent
FOR OFFICE USE ONLY
4
TENANT IMPROVEMENT
❑ AITION
DD
ALTERATION
° REPAIR °
° YES
PLAN?
❑ NO
❑ NEW
BUILDING SHELL ONLY?
°YES ONO
BASIC
❑ YES
CHANGE OF USE?
❑ NO
ZONING DESIGNATION
°YES
Up/SEPA/SU?
❑ NO
NEW ADDRESS REQUIRED?
❑ YES ❑ NO
IIDtED? ° YES
DEMO PERMIT REV
❑ NO
PLATTED LOT?
° YES ° NO
k1Hlu1d0utSlpr:r1nit Application
Page 2 of 4
Bulletin #100 — January 1, 2007