05-105745'A 0 �-k
Federal Way PERMIT RECGIV
MF CO ME EL PL DE EN
COMMUNITY DEVELOPMENT SERVICES
• 333 2 AVENUE SOUTH • BOX 97] 8
E ED ERAL 98063 -9778
253- 835 -2607-, FAX 253- 835 -2609 A P P L I C A T I O 065 � � �
www. atuoffederalwau.cam
The followina is reautred information - an incomplete applicatioi '> "PWANA ase print Legibly (in ink/ or type.
?ROPEKTY IIVB'OFi
SITE ADDRESS. 33`1 (S i t T WAS .SoQ-T ►A SUITE /UNIT # l C.Ci
ASSESSOR'S TAX /PARCEL # I Z 5 0 - U i 5 O LOT SIZE (sj)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
)Attach separate page for lengthy legal description)
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING 'N FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this Hermit onlul
Abp ! )ZE uo( -ATE: �PiZi t�iKr_CCLt �tL. i t= I.1A1J \ i1�P20.� hAENT
PROJECT NAME (Name of Business or Owner Last Name)
PEOPLE •• •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
NAME
kA LLC
PRIMARY PHONE -
MAILING ADDRESS
CITY, STATE, ZIP
COMPANY NAME
- iNTQ\O -v F(ZE -PWM—
APPLICANT NAME
iuA
OFFICE PHONE
(-t& is - 3
MAILING ADDRESS
270? 70 `T Fj !NV E c
CITY, STATE, ZIP
T&(-oMA \N A 769z,4
CELL PHONE
( -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
B L )/0 �
FAX NUMBE(RR
" I OD
CONTRACTOR'S REGISTRATION NUMBER (copy of card required with each application) EXPIRATION DATE
V A -1 ?-1 i P -L}9 �1 F
COMPANY NAME
APPLICANT NAME
OFFICE PHONE FF
MAILING ADDRESS ��^
Lam'
CITY, STATE, ZIP
CELL PHONE
( _
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe)
FAX NUMBER
(� q') - t
Nor jN E
PRIMARY P ONE
E-MAIL ADDRESS
PerRCLV'19
regriire2i
27 096 FLender i Lfon is
{f P? -
le �nk x
NAME
4
MAILING ADDRESS
CITY, STATE, ZIq
EXISTING USE �' -�- PROPOSED USE CAP F ( L
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $ yo V
SPRINKLERED BUILDING? YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? � YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
!-4
AREA DESCRIPTION
EXISTING PROPOSED TOTAL
Q. FT. SQ. FT. SQ. FT.
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK(COVERED ?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS atastteo 1110-- TOTU �R __...... r _...
* *NEWHOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of facture to be installed or relocated as part of this project. Do not include existing fixtures to
MCELAMCAL
--
Value of Mechanical Work $
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS LOGS
REFRIG. SYSTEMS
BBQS
FANS
HOODS (c..,ci.4
WOODSTOVES
BOILERS
FIREPLACE INSERTS
RANGES
MISC (Describe)
COMPRESSORS
FURNACES
GAS WATER HEATERS
DUCTS
GAS PIPE OUTLETS
PLUMBING
BATHTUBS (or Tub /Shower Combo)
SHOWERS
WATER CLOSETS (rnneq
MISC (Describe)
DISHWASHERS
SINKS
DRINKING FOUNTAINS
GAS PIPE OUTLETS
SUMPS
RAINWATER SYST
WASHING MACHINES
URINALS
HOSE BIBBS
LAVS pattwoms;woq
VACUUM BREAKERS
ELECTRIC WATER HEATERS
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, fees 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 DATE
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other
Bulletin # 100 — Januaiy 7, 2005
Page 2 of 4
WiandoutsTermit Application