04-101191RECEIVFQ
RECEIVVELOPMW
Cory OF
Federal Way
"P�tRMIT
APPLICATION
8FPVr.Es
33530 FIRST WAY SOUTH - PO BOX 9 718
MAR 3 129
0TTT'P%1
ASS ESSOR?S TAX/PARCEL #: Z 6 5- 0 1 - () 1 3 o 0
SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTION (e.g.: Acme Estates, Lot 1)
(Attach separate page for lengthy legaldescRp-ti-n)
TYPE OF PERMIT (This application): 13 BUILDING El PLUMBING 0 MECHANICAL 0 DEMOLITION
0 ELECTRICAL 0 ENGINEERINGIK FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit "nl -EE LOCATrAll, AAI?-,
A be I
t, t1'7j C
PROJECT NAME (Name of Business/Owner Last Name): R, 2 N HOD6E 5
iZ4 0 ME 01 Vi h D)
LENDER:
(If P-P ... d Val.. > $5,000)
-!5T-A V kl-E
79A—R-941- ADDRESS —(STRZET ADDRE
0 1 S KA
NAME
OL yA17p(1
I�AIDING —ADDRPSS(STREET ADDRE
P0,130y J() 0 Z-
CIrl OF �PFDEPAIWAY BUSINESS I,{— __ '0 Z-j a q- -
card required with each
PRIMARY PHONI&
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CITY� STATE, &P
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PoPLA0t> nR
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COMPANY
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(4Z5) Z77 54,4+
STATE, ZIP
7
CELL PHONS�
�CTIIY,
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Ir
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MNSE NU EN:
EKPI�RATIQN DATE.
PAX NUMBER:
UM
IER
MPIRATIONDA
�Tr-
Lication)
EXISTINGPROPOSED
USE:
EXISTING ASSESSED/APPRAISED VALUE
OF PROPOSED WORK:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
X YES 0 NO
)r LAKEHAVEN
o LAKEHAVEN
FIRE SUPPRESSION SYSTEM PROpOSED/REQUIRED?: E] YES 0 NO
o HIGHLINE 11 TACOMA El PRIVATE (WELL)
o HIGHLINE C3 PRIVATE (SEPTIC)
MECHANICAL
Value of Mechanical Work
AIR HANDLING UNITS
EVAPORATIVE COOLERS
BBQS _�'
FANS
BOILERS
FIREPLACE INSERTS
COMPRESSORS
FURNACES
DUCTS
GAS PIPE OUTLETS
PLUMBING
BATHTUBS (mrTub(Sh®wercombo}
SHOWERS
DISHWASHERS
SINKS
- GAS PIPE OUTLETS
SUMPS
WASHING MACHINES
URINALS
LAVS (Bathroom Sink
VACUUM BREAKERS
GAS LOGS REFRIG. SYSTEMS
HOODS (commerciai} WOODSTOVES
RANGES MISC (Describe)
GAS WATER HEATERS
CLOSETSWATER
DRINKING
RAINWATER SYS
HOSE BIBBS
ELECTRIC WATER HEATERS
Nal'a=
I= Mal
,. .
. against
Way, but +
NAME/TITLE: (Signature) mtw
dn�eoojo�c* upon the accurucy 4the inj�n ;�� to the city as a Part of this application.
.,?.ELATIONSHIP TO PROJECT: 0 Property Owner � Applicant o Contractor c Architect 0
Bulletin # 100 -January 13, 2004 Page 2 of 4 k:\Handouts - Revised\Permit Application