05-104543k�l
Federal Way V�pR WrT
COMMUN77Y DEVELOPMENT SERVICES
33325 AVENUE, WA 9 • P3 BOX 9718 EP oAPPLICATION
FEDERAL WAY, WA 8063.9718
253-835-2607•FAX 253.835-2609 C/7-y0
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The fold is required informa�s �'¢7t in�tete application will not be
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SF MF CO ME EL PL DE R9
Please
SITE ADDRESS . T A ,S G " `cy�C q— SUITE/UNIT tt
ASSESSOR'S TAX/PARCEL #
=-- � �� --� �.J � ..� LOT SIZE (s�
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page far lengfhy legal desmphm)
V
or
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING C],FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlupi
_De. �g. &1 �- .0 4 ' /� 7 P. � ,u l� P ✓ r- IS +�-� r Y .[� r��'/ r -�
PROJECT NAME (Name of Business or Owner Last Name) ���'r -.Te-4j S- v C U 54 n-4 rj+l
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
p OU v (-� 3
`- CITY, STATE, ZIP
1(6-7(k ST I 'RrJ/oevi,- \uC.—
COMPANY NAME 14el faa,.N f-•%e �f6�h+f. APPLICANT
LILI%CAN�T/j,�
MAILING ADDRESS CITY, STATE
24-e I1aJ
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EKPIUT-1 &N IM
CONTRACTORS REGISTRATION NUMBER {copy of cud regalrrd With each afaaEleatfeni
—1 ( ) -
` 16G
( )
CELL PHONE
iy ) y17 -579/
FAX NUMBER
r rl4A CnV1Y t5
MAILING ADDRESS CITY, STATE, ZIP — CELL PHONE
r 5 �r� w+4 9�r�� (,q vl� -S�gl
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe) ( }
IBC ►{ i11.0 f► �7 �7.7 a?.9.�
NAME
EXISTING USE t* I
r�1vf
PROPOSED USE �'All C ( I* fn
EXISTING ASSESSED/APPRAISED VALUE
VALUE OF PROPOSED WORK $ Fr, oofy
SPRINKLERED BUILDING?
❑YES I -VINO
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?— S ❑ NO
WATER SERVICE PROVIDERrAKEHAVEN
SEWER SERVICE PROVIDERAKEfi11VEN
❑ HIGHI.D?iE
❑ HIGHLM
❑ TACOMA ❑PRIVATE (WELL)
❑ PRIVATE iSEPTICi
AREA DESCRIPTION ....... (G
r
BASEMENT
PROPOSED
S . FT.
TOTAL,
S . FT.
�,
FIRST
/
SECOND''
THIRD
�
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
/
DECK (COVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
CQ`Srur°
lROrosED
J u
"IYEWHOMES ONLY" NUMBER OF BEDROOMS ESTIMATED LING PRICE $
t
Indicate number of each type of facture to be installed or relocated as part of this project.
Value of Mechanical Work
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
i /r
BATHTUBS (or7lib/Shower Combo)
6ISHWAS)fI RS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS III s nu i
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
include existing
GAS LOGS
HOODS (cummercist)
RANGES
GAS WATER HEATERS
WATER CLOSETS (Toil _
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
to remain.
REFRIG. SYSTEMS
� OODSTOVES
M [Describe)
MISC (Describe)
I certify under penalty of perjury that theWorihation furnished by me is true and correct to the best of my knowledge,, and farther, that I
am authorized by the owner of the above pr es to perform the work for which the permit application is made. If urther agree to hold
harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in the investigation and defense of
such claiml, which may be made by any person, Including the undersigned, and fled against the City of Federal Way, but on(/e where such clalm
arises out of the reliance of the city, including its officers and employees, upon the accuracy of the Information supplied to the city as a part Qf
this application.
NAME/TITLE
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑
Bulletin # 100 — January 7, 2005 Page 2 of 4 kkHandoutsTermit Application