05-105694i
RF.CEIVO
Federal Way PERMIT
commuimDEVELoFMERT SERvIfiD V 0 4 2005
33325 Sm
DEAL WAY, WA • Po Box 9718 XPLICATION
FEDERAL WAY, WA 98
453-835 ?607• FAX 2S3d� OF RAL:4
IU'�'• °h1°.7e�!•m[r'yamo n BUILDING DEPT
The folloudng is required information - an incomplete application will not be aced
PROPERTY •- •
SITE ADDRESS 3 � ��v �i t" &4,
ASSESSOR'S TAX /PARCEL # 2 Z Q -Q
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
- f0
SF MF CO ME EL PL DE El
Please
or
SUITE /UNIT #15 5-_
LOT SIZE (s,)
(Aaaah&"mt6Pwla t neft+moatdaw0doN
PROJECT • •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL -
❑ DEMOLITION ❑ ELECTRICAL ❑ XFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on Vi Us Dermit onlvl
PROJECT NAME (Name of Business or Owner Last Name) pv/yT - r V F— x
PEOPLE •- •
PROPERTY NAM ^ ^ PRIMARY PHONE
OWNER n .J/ -F- ..,/ . � , i _ n . i t /_ i . /,__,.j ,
CONTRACTOR
APPLICANT
CONTACT
COMPANY NAME
APPLICANT NAME
e-
OFFICE PHONE
( 2 -f
MAILING ADDRESS
C 731 ZZ?
CITY. STATE, ZIP
P' A a ( �� , iw-
CELL PHONE �DOn
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE -
FAX NUMBER
B'
L /
CONTRACTORS RE4iSTRATION NUMBER lcopy of card ragaiced with each application)
EXPIRATION DATE
0r
COMPANY NAME
E_ -S 4Alz" 1
LLB
APPLI NAME
JQAn C'f'
OFFICE PHONE
(253 )gy(o
-5y00
MAILING DRESS
CITY, STATE, ZIP —
CELL PHONE
OOS
RELATIONSHIP TO PROJECT
11 Architect ❑ Tenant ❑ Agent KOther (Describe)
FAX NUMBER
(7n ) 9"-/&
- S-L/0'1
I
■
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DES BE)
DECK (COVERED ?)
GARAGE G CARPORT ❑
NUMBER OF FLOORS sasrsro
�.:. 1SOPOSSD TOTAL
.. ..�.........,_..
... . ... HUME
"NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SE NG PRICE $
Indicate number of each type of fixture to be installed or rel ted
part of this project. Do not include existing fixtures to remain.
ABC AA7C4L
Value of Mechanical Work $
AIR HANDLING UNITS
EVAPORATI COOLERS
(;AAS LOOS REFRIG. SYSTEMS
BBQS
FANS
HOQDS (commeeciay WOODSTOVES
BOILERS \
F PLACE INSERTS
RANG MISC (Describe)
COMPRESSORS >
FURNACES
OAS WAT ,IH! TERS
\\
DUCTS
OAS PIPE OUTLETS
o.
PLUMBING
BATHTUBS (or Tub /S combo)
SHOWERS
WATER CLOSETS (leikq \ MISC
(Describe)
DISHWASHERS
SINKS
DRINKING FOUNTAINS
GAS PIPE ETS
SUMPS
RAINWATER SYST
WASHIN ACHINES
URINALS
HOSE BIBBS
LAV (94thcoemah"
VACUUM BREAKERS
ELECTRIC WATER HEATERS
I certgy under penalty of perjury that the tt{f ormation 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 officers and employees, upon the accuracy of the tqformatton supplied to the city as a part of
this application.
NAME /TITLE DATE
ature) (title)
RELATIONSHIP TOUPROJECT ❑ Owner ❑ Agent 11 Contractor ❑ Architect ❑ Other
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Bulletin # 100 — January �, 2005 Page 2 of 4 Wiandouts\Permit Application