06-101030CITY OF
F'ederafflay.on PERMIT
COMAIUM9YDEVELOPA(8NrS ,,,&R
3332S 8*II AVRNE SOL771 • PO BOX 9718
s 60,PAX2Sl -8 %r®F1=F-oE RPLICATION
itww,d9wf ftkrahiiac.eom BUILDING Ut •
is
- an
wdil not be
• Hrod = OY- / o S9/ (
0— - z-(:�- a,3-
SF MF CO ME EL PL DE E FP
Wed. Please print legibly (in dn11a or type.
SITE ADDRESS a 't / SUITE /UNIT # ;
ASSESSOR'S TAX /PARCEL # � Q _ _ 6 � - -0 -3 '1- LOT SIZE (sfl
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach -par—p f- ImWftIeVIdam!
PROJECT •• •
TYPE OF PERMIT ❑ BUILDING . ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING Q FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this vermit only)
l N S-rA Ltr A U (1 a "L� /-M) Je 7r 1< 'L -pppess (O Pi
PROJECT NAME (Name of Business or Owner Last Name) i j � R-6�%i4
PEOPLE •• •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
NAME' PRIMARY PHONE
O ( -
MAILING ADDRE CITY, STATE, ZIP
COMPANY NAME
- ( r; �
APPLICANT NAME
APPLICANT NAME
e,-- 7�y
OFFICE PHONE
(6&) s 2. -
CITY, STATE, ZIP
CELL PHONE'
a) ")�
FAX NUMBER
MAILING ADDRESS
CITY, STATE,
�� � �
/lA�� / o x
f�OX
�
(EI,L )ti-3
.�J7t -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
CONTRACTOR'S REGISTRATION NUMBER (eopy of card required with •aeh application)
EXPIRATION DATE
COMPANY hFA
APPLICANT NAME
OFFICE PHONE '
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE'
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑: Tenant ❑ Agent ❑ Other (Describe)
LENDER
MAI
EXISTING USE
EXISTING ASSESSED /APPRAISED VALUE
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER
SEWER SERVICE PROVIDER
d YES ❑ NO
VALUE OF
SUPPRESSION SYSTEM
• LAKEHAVEN ❑ HIGHLINE
• LAKEHAVEN . ❑ HIGHLINE
1j.--7 E-MAIL ADQ=
PHONE
7
USE
' SED WORK II rT! t✓ vt✓ v
PROPO ED � RE Li NO
❑ YES
/ UIRED? Q r.
• TACOMA ❑ PRIVATE (WELL)
• PRIVATE (SEPTIC)
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
3 . FT.
TOTAL
S . FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESC E)
DECK (COVERED ?)
GARAGE O CARPORT ❑
smnso rsorosso rorN.
NUMBER OF FLOORS
* *NEW HOMES ONLY** NUMBER OF BEDROOMS 617IMATED SELLING PRICE $
Indicate number of each type of fixture to be in,,stalied or relocale4 as part of this project. Do not
AMCHANICAL
Value of Mechanical Work $ f
AIR HANDLING UNITS J '� EVAPORATIVE COOLERS G GS
BBQS FANS HOODS (c erc(d)
BOILERS' FIREPLACE INSERTS RANGES
COMPRESSORS FURNACES GAS WATER HEAT
DUCTS GAS PIPE OUTLETS
BATHT,{MS (ocnb /--t4
DISHWASHERS
('!(S PIPE OUTLETS
WASHING MACHINES
LAVS m ft a sb kd
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
WATER CLOSETS troaeq
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
to remain.
REFRIG. SYSTEMS
WOODSTOVES
MISC (Deacn'be)
MISC (Describe)
I cert(jy under penalty of perjury that the irVarmation furnished by me is true and correct to the best of my knowledge, and further, that I
am authorised by the owner of the above premises to perform the work for which the permit application is made. I further agree to hold
harmless the City of Federal Way as to any claim one it n costs, expenses, and attorneys' fees incurred in the investigation and defense of
such claim), which may be made by any person, ine ing undersigned, and filed against the City of Federal Way, but only where such claim
arises out of the reliance of the city, including its cars employees, upon the accuracy of the Wormation supplied to the city as a part of
this application.
NAME/TITLE �' "� i v DATE ✓ — 3
(Signature) Mae) � CO
RELATIONSHIP TO PROJECT a Owne O Agent t7 Contractor O A v rchitect Other [� � L 1M. li (TZ IIL
t IIAA6 U.-9 ..fA LAWae AmoAPP' 4 Annliretinn