06-101426RECEIVED
Fedefai Way
COMMUMNDEV=PAfW SERV = 0Af PERM IT
333258"'%UWA.UAq . pp9718 PLICAT 1�T4 Zoos
FEDERAL WAY, AA 98063 -9718
1 253- 835 -2607• FAX 259.635 -2609
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CITY OF FEDERAL W
Thefollowing is required information _ ,..,.,n- AUILQ)NGAEPT. _
.l!�- o � y 2!
SF MF CO ME EL PL DE EN.
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:ed. Please print legibly rin ink) or tun
SITE ADDRESS 0511 't Z £�(o k- / SUITE /UNIT #
ASSESSOR'S TAX /PARCEL # 2, LOT SIZE (sfl
LEGAL DESCRIPTION leg. Acme Estates, Lot 1)
TYPE OF PERMIT
PROJECT DESCRIPTION (Provide
PROJECT INFORMATION
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING "ip'Fm PREVENTION SYSTEM
PROJECT NAME (Name of Business or Oulner Last Name)
PROPERTY
OWNER
4'', 0
' °""""'°"a`u �•v +�
BASEMENT
EXISTING PROPOSED TOTAL
. SQ. FT• S . FT.
FIRST
SECOND
❑ YES a NO
THIRD
❑ YES
FOURTH
ZONING DESIGNATION
ADDITIONAL FLOORS (DESCRIBE)
CHANGE OF USE?
DECK(COVEREDII
o NO
GARAGE ❑ CARPORT ❑
a YES a NO
NUMBER OF FLOORS �81p`6 P1OPO�D
• "NEW HOMES ONLY"* NUMBER OF BEDROOMS
°L� er Torer.raoroM By
ESTIMATED SELLING PRICE $
each type of fixture to be i istalled or relocated as part of this project Do not include existing f ixtw'es to remain.
Value of Mechanical Work
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS
REFRIG. SYSTEMS
BBQS FANS HOODS (Commacw) DSTOVES
BOILERS FIREPLACE INSERTS RANGES WOOOO STOVES
COMPRESSORS FURNACES GAS WATER HEATERS M(ISC
DUCTS GAS PIPE OUTLETS
BATHTUBS (WlUb /Sho Cambo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
WATER CLOSETS awk* _
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
MISC (Describe)
am I
authorized de t of perjury that the igformadon furnished bg me is true and correct to the best of my knowledge, and further, that I
of the above premises to perform, the work for which the permit application is made. I further agree to hold
harmless the City grFederal Way as to any claim (including costs, expenses, and attorneys' fees incurred In the investigation and dqfense such clai* which may be made by person, including the undersigned, and filed against the City ofFederal Way, but only where claim
arises out qr the reliance of the luding its offlo— and empi ogees, upon the accuracy of the ir0 ntation supplied to the city as a part of
this application, j
NAME /TITLE DATE 312, -3 / 0&
(swat—) rntle) �� —f
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent '6/61ntractor ❑ Architect ❑ Other
❑ NEW ❑ ADDITION
❑ ALTERATION -
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES a NO
BASIC PLAN?
❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
o NO
NEW ADDRESS REQUIRED?
a YES a NO
UP /SEPA/SU?
❑ YES
❑ NO
PLATTED LOT?
❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
nullenn 4F1 W — January 1, 2006 Page 2 of 4 k\IandoutslPermit Application