06-106296RE.Cr-~~ED
Ql'UF ~ · . (' ,(' ft 1)006 . ' "
FederalWay r.r: , .) '-· PER.MIT
00/IIMUNl'Tl' DBV/U.OPMENT SBRVIC£S ~AL v/A '/
3332S l!"'AVINUF.30Ulll•POBOX9 11~\1Y Or f r.O ¢Pl"n LI CATI o· N
FF.l)ERl,L WA Y, WA 98063-9118 G ou\\..OIN .r · r
253~J S-2607• FAJ<. 2S3..!35-2609 u
www,cftuoffecf<rqlwgy, com
SITE ADDRESS __ '2._=-f _0_1_.___')_._~_UJ __ i...._"S"_r. __________ --'-
ASSESSOR'S TAX/PARCEL # _J 1 Ji~ :12 -_b C _J_ b
I /·
SUITE/UNIT# ----
LOT SIZE (s.fl
LEGAL DESCRIPTION (e.g. Acm.e Estates, Lot l) ___________________________ _
· · . . . • PROJECT INFORI\IATION
TYPE OF PERMIT DBUJLDING 0 PLUMBING D MECHANICAL
0 DEMOLITION D ELECTRICAL D ENGINEERING li,;rF"fRE Piu:yENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on th.is permit onl!/}
., 4-o~ ... o~ ,"\?_~"--~~~e .. s . ~i..>k .L~ ~. t?·U ·· cf:. ·.-;-uu · ~H-B.1.._
.. PROJECT NAME (Name of Business or Own.er Last Na me) --~--..:)~· ~~-~~.,.__--~-~-~-"-~~-~~--------------
PROPERTY
OWNER
·. · • PEOPLE INFORMATION
MAIUNO ADDRESS
lJ"O -$ . t>~~ O'i,
CllY, STATE, ZIP
~"r , 'ko v..., v; t,.\., () • l.u :!:> i 4'f-
CONTRACTOR
' '.
APPLICANT
CONTACT
LENDER
APPUCANT NAME
.-.J et'\---) ~i>...i.,~
cm/ OP-FEDERAL WAY BUSINESS LICENSE NUMBER
1 't_~j i-.L;. (l_ ~ 1: J. ~-a ·L
CONTRACfOR'S REGISTRATION NUMBER (cop7 o r cud req.ued with ucl• •ppllcatlonl
~NYNAME APPUCANT NAME
A )M.;Q.. A.a-':> -Ab t.\1--~,
MAILINO ADDRESS CITY, STATE, ZIP
REV.TIONSHJPTO PROJECT
o Architect o Tenant o Agent o Other (Describe)
CEJ-LPHONE
(~2-f ) 1~ I" ~J._oq,
'FAX NUMBER
(fi._s } ~,~ \ · J03P
EXPIRATION DATE
It-I ~l '•0
OFFICE PHONE
( ) -
CELLPHONE
( ) -
FAX NUMBER
( ) -
. . . . . • DETAILED BUILDING INFORl\tATION . . ·
EXISTING USE __________________ PROPOSED USE ---------------
EXISTING ASSESSED/APPRAISED VALUE $. _________ VALUE OF PROPOSED WORK $._t~f_O"O_._t!D ____ _
SPRINKLE~DB~DING? s'YES aNO
WATER SEl_lVICE PROVIDER l!(LAKEHAVEN
SEWE,R SERVICE PROVIDER O LAKEHAVEN
FIRE SUPP~ION SYSTEM PROPOSED/REQUIRED? m--YES
a IDGHLllfE Cl TACOMA o PRIVATE (WELLt
o ffiGBLINE . a PRIVATE (SEPTIC)
D NO
BASEMENT
FIRST
SECOND ,.
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED?)
GARAGE D CARPORT D
NUMBER OF FLOORS
PllON>sO:O totAL
'"NEW HOMES ONLY,.. NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES .
. . ··-. ---.
Indicate number of eacJ:i. type of fixture.. to be installed or relocated as part of this project; Do not in~ude existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDUNO UNIT3 EVAPORATIVE COOLERS GAS LOGS R EFR!G. SYSTEMS
BBQS FANS HOODS (Com.m.uclalj WOODSTOVES
BOILERS '" Ff.REPLACE INSERTS RANGES ' ..... MIE}C (Describe)
· COMPR~SORS .. .. FURNACES ~AS WATER Hit,\~
DUCTS OAS PIPE OUTLg'J"S
PLUMBING
BATHTUBS [orful>/Sho,..r C.,mbo) SHOWERS WATER CLOSETS (l'oe4 MI SC (Describ e)
DISHWASHERS SINKS DR!NK[NO POUNTAll'ofS
OAS PIPE OUTLe:TS SUMPS RAINWATER SYST
WASHCNO MACHINES URINALS HOSE BIBBS
LA.VS (BalhtoomSmbl VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAil\lER/SIGNATURE BLOCK , . .
1 certffy under penalty of perjury that the ln.fonnatton furn.($hed by me l$ true and correct t~ the best of my knowledge, and furthu, that 1
cun authorized by the owner of the abo1Je preml$e$ to perform the work for which the permit application ls made. 1 further agree to hold
hannlus the City of Federal Way as to any claim (fncludln,g com, u:peR$e$1 and attonuy~ feu incurred fn the tnvuttgatlon and defenH of
such clalmJ, whlch may be made by any person, Lncludtng the undersigned, and filed against the Cfty of Federal Way, but only where such claim
arbu out of the reliance of thJl city, Including tu offlcen and employee6, upon the accuracy of the in.fonnatton supplied to the city as a part of
thu apprtcatto~
1
<;_ ~ . _
NAME/TITLE ~---+----....._--+--~--~-------------DATE _f_L-"-----'l'-~-,..-<Jb ____ _
(Signature) (Tille)
D Architect RELATIONSHIP TO PROJECT o Owner a Agent B'Contractor a Other _____________ _
Bulletin #HOO-Januaiy 7, 2005 Page2 of4 k\Handouts\Pennit Application