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05-105338
RECEI)fD Federal way PERMIT �itVfYUevscorxsxr CT 1 7 20 5 833 ?S d� A�SMlB S0fllil• P0� P L FEDERAL WAY, X 53435.26o I C AT I O N 253- 835-2507• FAX 253- d35 -Y609 .2`ITY OF FEDERAL Y BUILDING DEPT. The following is required information - an incomplete application will not be SF MF CO ME EL PL DE ENO EEFp d. Please print legibly (in inkJ or tune. SITE ADDRESS ) d SO L( 3� � "y ty SUITE /UNIT # ASSESSOR'S TAX /PARCEL # :- 1;?, _ G � � --C)a LOT SIZE (sj) LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) IAewd'+epa-tvPWla ka,w kgd d-aodW _ TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 0 MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL 0 ENGINEERING -'b FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this ve rmit onl Uaz1 PROJECT NAME (Name of Business or Owner Last Name)(, PEOPLE •- • PROPERTY OWNER CONTRACTOR L APPLICANT CONTACT LENDER EXISTING USE NAME PRIMARY PHONE MAILING ADDRESS CITY, STATE, ZIP 6L0 Sw" 5ue a +a-n W_A COMPANY NAME_ Sivi; t- ` r^e S vi,5 APPLICANT NAME i c h 1 0 OFFICE PHONE (.'x.531 i ;�,6 - / r MAILING ADDRESS CITY, STATE, ZIP CELL PHONE CITY OF 'FEDERAL WAY BUSINESS. LI ENSE NUMBER ® -B' EXPIRATION DATE ,= 'FAX NUMBER RELATIONSHIP TO PROJECT L. 0 Architect 0 Tenant 0 Agent 0 Other (Describe) CONTRACTOR'S REQ1STRATI6N NUMBER (copy of card required with each application) 5 IL L 11-4 E S L � '4 j- EXPIRATION DATE It 0( /, COMPANY NAME APPLICANT NAME OFFICE PHONE G C _ MAILING ADDRESS CITY, STATE, ZIP - /CELL PHONE l � - RELATIONSHIP TO PROJECT FAX NUMBER 0 Architect 0 Tenant 0 Agent 0 Other (Describe) PROPOSED USE EXISTING ASSESSED /APPRAISED VALUE VALUE OF PROPOSED WORK s 51 �/ ©, 00 SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? O YES 0 NO WATER SERVICE PROVIDER O LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE (WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 BIGHLINE 0 PRIVATE (SEPTIC) AREA DESCRIPTION I EXISTING I PROPOSED � TOTAL SQ. FT. SQ. FT. SQ. FT. BASEMENT t THIRD FOURTH '. ADDITIONAL FLOORS (DESCRIBE) DECK (COVERED ?) GARAGE O CARPORT O NUMBER OF FLOORS yQBT °o ncoroscn mta '° ,3 Indicate number of each type MECKANICAL Value of Mechanical 'Work $ AIR HANDLING UNITS BBQS _T BOILERS •• COMPRESSORS DUCTS tsnrrrru (or7Lb /Sbouer Combo) DIS HERS PIPE OUTLETS WASHING MACHINES LAYS maftoomsiotcr to be installgdlbr relocated as piaut of this Do not include exisWu; fixtures to EVAPORATIVE COOLERS OAS LOGk REFRIG. SYSTEMS FANS HOODS (c!e,8q WOODSTOVES FIREPLACE INSERTS RANGES ' R, MISC (Describe) FURNACES OAS WATER HEATER§' GAS PIPE OUTLETS SHOWERS WATER CLOSETS ( n q MISC (Describe) SINKS DRINKING FOUNTAINS SUMPS RAINWATER SYST URINALS HOSE BIBBS 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 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 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 ofJleers and employees, upon the accuracy of the information supplied to the city as a part of this application. NAME /TITLE DATE b — / 7 — O (Signature) (Tate) RELATIONSHIP TO PROJECT o Owner o Agent o Contractor o Architect Other CO Lk 1" 1 L k Bulletin #100 —January 7, 2005 Page 2 of 4 MHandoutMWennit Application