04-103832PROPERTY INFORMATION
SITE ADDRESS SUITE/UNIT
ASSESSOR'S TAX/PARCEL # LOT SIZE (so
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page for lengthy legal d—ription)
TYPE OF PERMIT o BUILDING 0 PLUMBING o MECHANICAL
ii DEMOLITION"9 ELECTRICAL Ei ENGINEERING Ei FIRE PREVENTION SYSTEM
PAOT DESCRIPPOTf (Provide is description o f work it duded on this permit only
I
PROJECT NAME (Name of Business or Owner Last 1Yar t �` �'ZO UC 4KA-)
1111111111111 R-1 "91
Kf)a4x—jN
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ UE OF PROPOSED WORK
SPRINKLERED BUILDING? YES [3 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? D YES 0 NO
WATER SERVICE PROVIDER 13LAKEHAVEN 11 HIGHLINE 13 TACOMA 0 PRIVATE (WELL)
SEWER SERVICE PROVIDER EILAKEHAVEN Ei HIGHLINE o PRIVATE ISEPTIC)
r 11L I: U 11 Z15
�r • _ �� r' r �... .. � �. a . �'. � � s is-, ,�+ • ♦:.
MECAAMCAL
Value of Mechanical Work $
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS LOGS
REFRIG. SYSTEMS
BBQS
FANS
HOODS (commerew)
WOODSTOVES
BOILERS
FIREPLACE INSERTS
RANGES
MISC (Describe)
COMPRESSORS
FURNACES
GAS WATER HEATERS
DUCTS
GAS PIPE OUTLETS
PLUMBING
BATHTUBS (or Tub/Shower Combo)
SHOWERS
WATER CLOSETS Toilet)
MISC (Describe)
DISHWASHERS
SINKS
DRINKING FOUNTAINS
GAS PIPE OUTLETS
SUMPS
RAINWATER SYST
WASHING MACHINES
URINALS
HOSE BIBBS
LAVS;Bathronm.Sis1
VACUUM BREAKERS
ELECTRIC WATER HEATERS
I certify under penalty ofpe�� that the information furnished by. is true and correct to the best of my knowledge, andjurther, 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
this application.
NAME/TITLE,y
A•k DATE 9
RELATIONSHIP TO PROJECT D Owner 13 Agent El Contractor 0 Architect 1:1 Othe
Bulletin #100 — March 30, 2004 Page 2 of 4 k\Handouts — Revised\Permit Application