07-104073J
eirr of
FederalWay. PERMIT
33325 SWA SOUK! • PO BOX 9718 p p I AT I N
FSDL1ORAL $RAL WAY, WA 980S3A718
253-635-Z607• PAK 20.89$.06d9' I-, I-} [ I i F; I. Y .� .
- 9"'-ff"`619'"""` I!' UILDING DEPT.
The follouring is required information -an incomplete application wtii not be
f>_-JA 4� 0
SF MF CO ME EL PL DE EN
�ted. Please print leaiblu fin 1nkl or trine.
SITE ADDRESS V �Ii=�— n) SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # A - `I i _� r LOT SIZE (SO
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) loll jZ) S-n A &&
(Attach sq.—ftpalefw Imgft ftal de—i,tf q
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING IKj FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
i oov- %.P 5(1£f sc�ioip)
ex —
PROJECT NAME (Name of Business or Owner Last Name)
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
NAMR PRIMARY PHONE
MAILING ADDRESS CITY, STATE, ZIP
COMPANY NAME
ze� � l
APPLICANT NAME
c, � -VC �
OFFICE PHO E
(`Z��
MAILING ADDRESS
�f 5
CITY, STATE, ZIP
� A- �0
CELL PHONE
( ) -
CrrY OF FEDERAL WAY BUSINESS LICEH E NUMBER EXPIRATION DATE
(—/ 31 / 0-7
FAX NUMBER
(7,00
B L
CONTRACTOR'S REGISTRATION NUMBER (copy of card required with each eppllcatlop)
S PrN'D G 5 5 2-1 0 fZ-0
EXPIRATION DATE
/ / U
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
✓r_11�1C U�
( � -
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE '
RELATIONSHIP TO PROJECT �j
FAX NUMBER
❑ Architect ❑:Tenant ❑ Agent ❑ Other (DescWl �l�
(n- U -
NAME
MAILING ADDRESS CITY, STATE, ZIP `PHONE S
DETAILED S . ! ■
EXISTING -USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ —VALUE OF PROPOSED WORK ilk, 0c)
SPRINKLERED BUILDING? ❑ YES Q NO FIRE SUPPRESSION SYSTEM PROPOSED%REQUIRED? X7ES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWF,R SF.RVi(_F, PRnVMP..R n T.ATIF.TTAVF.N" n TTTr_TTT.TNP. r, UT?TVATF I.QMIMM r+I
PROJECT' FLOOR AREAS
AREA DESCRIPTIOE
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
SO. FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED?)
GARAGE ❑ CARPORT ❑
r.utnxo ■xopa9lts Torv. %is np�. e .
NUMBER OF FLOORS
*•NEWHOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fkture to be installed or relocated as part of this project. Do not include existing fixtures to remain_
Value of Mechanical Work $
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
.DUCTS
PLEWING
BATHTUBS (or Tub/shower Combo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS (Sathroom Zink-)
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS (commerdol)
RANGES
GAS WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
WATER CLOSETS (roaeq MISC (Describe)
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that r
am authorized by the owner of the above premises to perform the work for whlcle the permit application is 'made. I further agree to hold
harmless the City of Federal Way as to any Claim (including costs, expanses, and attorneys' fees incurred in the investigation and defense of
such claim), which may be made by any person, including the undersigned, and filed against the City of Federal Way, but only where mach claim
arises out of the reliance of the city, i ding its officers and employees, upon the accuracy of the information supplied to the City as a part of
this applicatio J '
NAME/TITLE { G� ' DATE J
PROJECT Q Owner b Agent Contractor ❑ Architect 17 Other