04-104917MY OF
Federal way
3
� . F E R M I 1 .F� �IVEL
MF CO ME EL � PL DE EN COMMUNAYDEVELOPMENTSERVICES
332 AVENUE SO Po�X9718
FED ERAL WAY, WA 98 063 5 97]8 fD 253- 835 -2607• FAX 253- 83-2609 � A P P LI CATI S
wtow. dtyo(edera1teaa.com b 2002
The followinq is
- an inco
SITE ADDRESS WAccy SWTH
J
ASSESSOR'S TAX /PARCEL # 9 Z O / - a I
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Aaach separate pay - f lengthy Iegai de- .p,COn)
■ PROJECT INFORMATION
Please
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
or
SUITE /UNIT # /0()
LOT SIZE (sj)
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING WFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
S -441 - F=2P )0A i � -T-X-qN SySTFW TAJ NFL (
PROJECT NAME (Name of Business or Owner Last Name) —� W QO r] /
PEOPLE • •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
NAME T(20(0) RIMARY PHONE
6UVN� �/�jU Z23- S06
MAILING ADDRESS CITY STATE, ZIP
um /0&-r-11 v ti N E- '�� � BF.L.L V U W A► 7 eooy
COMPANY NAME
PATj2zoTZ )0
le EGT�
APPLICANT NAME
3o1S Foy E12,
OFFICE PHONE
(253) ZSy 3yOS
MAILING ADDRESS
-,;aT' AvF- -
CITY, STATE, ZIP
IAcA A 9V4zLt
CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
/ q-7 L - 0 / I T 9 -13
FAX NUMBER
)-28,q -2 1/o co
-1 L
CONTRACTORS REGISTRATION NUMBER (copy of card required with each application( EXPIRATION DATE
FAA 2zFLO G9 9 C F /o/ S12oo6-
COMPANY NAME
14 K:Lo-r 10ROTE'r✓
APPLICANT NAME
C908 Fo- csB$.,I 4
OFFICE PHONE
(2,5'3) 2N - 310S
MAILING ADDRESS
27X7 ?b7gJ AU F
CITY, STATE, ZIP
i AKdmA Iwo
,CELL PHONE
-
RELATIONSHIP TO PROJECT • 5 U.&66 t 7 ACT(
❑ Architect ❑ Tenant ❑ Agent 15- Other (Describe) !
FAX NUMBER
( 2S3) zry - ti yo
NAME PRIMARY PHONE E -MAIL ADDRESS
S6)L 92 2PI -3yos" 13 /�i4�tznrl t,
ti
yPerRCW �9 7 095 Lender inforntatiort is
NAME
required ;f project value ex'cee'ds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
EXISTING USE /V / / ) /V Cv,:, aVILe-,� PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $ Z-31200
SPRINKLERED BUILDING? O YES *NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? IRYES ❑ NO
WATER SERVICE PROVIDER ALAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
Value of Mechanical Work
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG. SYSTEMS
BBQS FANS HOODS (com mizl) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC (Describe )
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
BATHTUBS (or Tub /Sh—r Combo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
WATER CLOSETS Roney
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
MISC (Describe)
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I
am authorized 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' Jees incurred in the investigation and defense of
such claim), which may be made by 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 officers and employees, upon the accuracy of the information supplied to the city as a part of
this application. \
NAME/TITLE"/ 'I
(Signature)
RELATIONSHIP TO PROJECT ❑ Owner
(Tnte)
❑ Agent X Contractor ❑ Architect ❑
DATE toy
, FOR OFFICE USE QNLY '
a NEW o ADDITION
o ALTERATION
o REPAIR a :TENANT IMPROVEMENT
BUILDING SHELL ONLY?
a YES ❑ NO
BASIC PLAN? o YES
a NO
ZONING DESIGNATION
CHANGE OF USE? o YES
o NO
NEW ADDRESS REQUIRED? o YES o NO
UP /SEPA /SU? a YES
o NO
PLATTED LOT? o YES ❑ NO
DEMO PERMIT REQUIRED? ❑ YES
o NO
F
Bulletin # 100 — March 30, 2004 Page 2 of 4 k\Handouts — Reviseffertnit Application