04-100586w,
n
AI E'ELA3F*5S'E1TTSf.'RViC'FS
Federal Way
PRMIT
.APPLICATION �� ��� � 9$83061519171289
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FW File NLllilber: '- rT�.
The olloeraiir fs r raird rz o �€tiox —art irtccar°ra life lication urili not be teecc mod. Please tint T� ih1
(in ink) or ,
SITE ADDRESS:
..
ASSESSOR'S T /P CEL : .SUITE/APT #013 �.
SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTION (e.g.: Acme Estates, Lot 1)
(Aitilch separate page•,(aar i�igtfag Caicaa des�rslstt�yay
TYPE OF PERMIT (This application)-. 0 BUILDING ❑ PL iNO I `
El ELECTIRMUICA.L ❑ EIIGixEE ❑ DEMOLITION
Ca F PREVENTION SYSTEM
PROJECT DESCRIPTION (Provided said d deSCKP6011 of work inet ded on this l rmi �srlii .
i
PROJECT XAInyA1on,,o irts Owner Ll2StXarra:
Le
Jim —
PROPERTY rAfrE.
O ER F9iff9ARY t'RiONE,
MAILING AIXMESI3 (STREET ADDRESS�jl� Crry, STATE. zip
CONTRACTOR. 14AME
f � COM RA
J h OFFICE f'F ONF-;
MAJEWj rG ADDIPRE WREET AEORESS, -
CITY, STATE . 7l f)
CI�' �f°"EL9EaSAf. Air �iusf�aE LICENSE NUMBER.,
E f'iETATtt to fsn7E. FAX NUMBER,
Cc NTI CTOR itEC,t i (;AT 9C N t fi PhttlEP:
(copy of card required with each application) E P.IRATfON DATE;
NM
,l/ / t /
LENDERAE:,...' — — ...
(If Pe P--d V.1_> $5,000, t�A^aTif�tE.. PHONE:
MAWNG A€ DRESS ( REF r Al It ESSw): t )
CITY, M%TE, ZtP
APPLICANT: NAME.
COMP raY OFFICE5f1�3 x
t A f 9NG AbORE )STRLFT A RESS):el' t e ( -
Cf W, STATE, ZIP EVENING N4Na f EiC7hSE:
RE 99 AATIONSftIPTO PROJFCT: /
, l )
❑ Architect ❑ Tenant then (De crime ,Jt FAX NUNIBM
l -
CONTACT,PERSO FOR THIS PROJECT: ❑ Property Owner
ontractor ❑ Applicant E'd+ ATL ADDRE S:
EXISTING USE:
PROPOSED USE: ✓
EXISTING ASSESSED/APPRAISED VALUE
VALUE OF PROPOSED WORK: �
SPRINKLERED BUILDING? ❑ YES
❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ UI?:
WATER SERVICE PROVIDER ❑ L HAVEN ❑ HIGHLINE ❑ TACOMA (WELL)
• . ❑ YES ❑ NO
SEWER SERVICE PROVIDER ElLAKEHAVEN ❑ ❑ PRIVATE HIGHLINE ❑ I ATE (WELL)
(SEPTIC)
i
„m
AREA ITS S("`RIP'1"IGN r_
BASEMENT
FIRST
SECONDw� �.
THIRD ._
FOURTH
Off-r }NAt. FLOORS
iECI C ( Fit"
R.d AR'+A47E jG AO'vPLl lb .1"' TOTAL II AND PROPOSED
TOTAL EXISTING TOTAL PROPOSED
LOOR
FSTINIA"6TED SELLING PRICE _$
**NEW HOMES ONLY** NUMBER OF BEDROQMS: i� � _�� .
elocated as part othis project. Do not
Indicate number of each typ
e of Liarturc that is to be installed or rf include aerating fixtures to remain.
jmECHANICAL
u._
value of h7 cltr�aate��l w .�' €
GAS LOGS REFRIG. SYSTEMS
flVAP RNTIVE Ct�t�l.ER',' WOODSTOVES
11fiI ti 1Ni�L1NCG UNITS_... HOODS (com�crcba{
FANS RANGES MISC (Describe)HI t3S IRIsP[ iCEINSERT5 _
BOILERS FURNACE$ GAS WATER HEATERS -COMPRESSORS O,,S I*6I'1i OUTLETS
DUCT
LIJMBI14G tIISC (Describe)
SHOWERS WATER CLOSETS{sott�l{ ®�mm,--.,—"".
BATHTUBS I.,T..l,/Sh—Comlm) SINKS DRINKING FOUNTAINS
DISHWASHERS SUMPS RAINWATER SYS
"". ..`
GAS PIPE OUTLETS URINALS HOSE F IBBS ,
WASHING MACHINES VACUUM BREAKERS
ELECTRIC WATER HEATERS
LAYS (Bauuoom SL*
M
I
I oeriify under penalty of perjury that the information furnished by me
is e and correct to the best of y
Less the City of Federal Way as to any claim (including costs,, the and
knowledge, and fiord - that I am authorized by the owner of the above premises to perform the work for which the perms
which y de by any person,
application is made. I further agree to hold arises out o the reliance of the city,
attorneys' fees incurred in the investigation and defense of such claim/ ® this placation.
the accuracy of the information supplied to the city apart f
undersigned, andA,employces,
ld against the City of Federal Way, but only where such claim
so
including its Off
N E/TITLE: ._"_m �..., (Tide}
.�,stts actor. ❑Architect ❑
RELATIONSHIP TO PROJECT: ❑Property Ottiner ❑ Appiacant
FOR OFFICE USE ONLY: _ -. _ - B o TENANT I PRO JAENT
❑ ADDITION ❑ ALTERATION �_ _ YES ❑ O
❑ NEW ❑ REPAIR �ASIC PLAN?
BUILDING SHELL ONLY? ❑ ❑ NO
u YES ❑ NO
-"� CHANGE OF USES
ZONING DESIGNATION - ❑YES
Up/SEPA/SU?
u NO
w
NEW ADD S REQUIRED n YES u NO -- UIRED?„ ❑ YES ❑ NO
_ . �. . .....�_. DEMO PE ITR.EQ .�.,
PLATTER LOT? ❑ YES ❑ NO _
- _ ..
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