06-101785a" OF EVE
Feder�a� Way. REC PERMIT
COMMINITYDBVSLOPI(6ff S1 RV=s
333 F TWA w 8 3.B9XcM 1 0 Zoo APPLICATION
253.835.2607- FAX 253.835.2609
uww dtt e th r U
'—" V1( OF FEDERAL WA
01.11 r_ntr,tn nct3T
- an incomplete annlication will not be
'1� 6- -t 0-f:z f s-
SF MF CO ME EL PL DE EN P
SITE ADDRESS
��s� "�� �, � 1 . 6ITIYUNIT ik
ASSESSOR'S TAX/ EL # LOT SIZE (sj
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(A— mw— twfakMwb9ald ON
PROJECT •- •
TYPE-OF-PERMIT
❑ BUILDING . ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ;I FIRE PREVENTION SYSTEM
PROJECT. DESCRIPTION (Provide detailed description of work included on this permit onlvl
PROJECT • Owner
PEOPLE INFORMATION
PROPERTY
OWNER
is
CONTRACTOR
APPLICANT
CONTACT
LENDER
NAME PRIMARY PHONE
ILING ADDRESS CITY, STATE, ZIP
1 �_ L•
iRij=L21
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
—y
( 6�,J
G
CITY F FEDERAL WAY BUSINESS LICENSE NUMBER
'CITY, STATE, ZIP
ffl "�-I I VI I
GArimATION DATE
/ /
CELL PHONE
CELL PHONE'"
FAX ER
L
CONTRACTORS REGISTRATION NUMBER )coP7 of cc�ard required with sech application)
EXPIRATION DATE
FAX NUMBER
.124
ICLQ--i
COMPANY NAME
APPLICANT NAME
OFFICE PHONE '
MAILING ADDRE93
CITY, STATE, ZIP
CELL PHONE'"
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑:Tenant
O Agent. ❑ Other (Describe)
( -
EXISTING USE IQ PROPOSED USE DF� /GC
LISTING ASSESSED /APPRAISED VALUE S$ VALUE OF PROPOSED WORK
SPRINKLERED BUILDING? YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED %REQUIRED? YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER O LAKEHAVEN . ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
0
•
AREA DESCRIPTION
EXISTING
8 . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
/-�
_ BOILERS
FIREPLACE INSERTS
FIRST
IVIR
�--- -
---- --
SECOND
3,167,
THIRD
_
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED ?)
GARAGE 0 CARPORT 0.
OF FLOORS
tsmaro
nwrwso
TOTAL
"NEWHOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
number of each type of fixture to be installed or relocated as part of this project. Do not
Value of Mechanical Work V
_ AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS LOGS REFRIG. SYSTEMS
BBQS
FANS
HOODS lcem ,.iq WOODSTOVES
_ BOILERS
FIREPLACE INSERTS
RANGES MISC (Describe)
_ COMPRESSORS
FURNACES
GAS WATER HEATERS
.DUCTS
GAS PIPE OUTLETS
BATHTUBS (wTub/snm a —bo)
SHOWERS
DISHWASHERS
SINKS
GAS PIPE OUTLETS _T
SUMPS
WASHING MACHINES
URINALS
LAVS (9.&re.m swro
VACUUM BREAKERS
WATER CLOSETS (roeeq ,C MISC (Describe)
DRINKING FOUNTAINS F I" SRR-1014- -
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
I certify under penalty of perjury that the btformation 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 (including costs, expenses, and attorneys' fees incurred in the investigation and defense of
such claimb which may be made bg any person, including the undersigned, and filed against the City of Federal Way, but only where such claim
arises out of the reliance of the city, including its ofjleers and employees, upon the accuracy of the information supplied to the city as a part of
this application.
NAME /TITLE �� /�- ✓ /Gh— 4i20_j E' GT A) S 1 Gnat -L DATE iF—
(sign re) (Title)
RELATIONSHIP TO PROJECT q Owner t7 Agent o Contractor ❑ Architect 1K,0ther SP2) AJY.LA: – 60NTA&I04.
J
Bulletin #100 —January 1, 2006 Page 2 of 4 MandoutsTerinit Application