05-102881MY OF R C �
Federal way 'PERMIT
33325 8MAVVEME • NO BOX 97181) U N 1 I
FEDERAL WAY, WA 98063 -9718 APPLICATION
253- 835 -zsm• FAx 53 -835-Q 17Y O F F
_, .enruftcaec:i:c,ca,. or, EDERAL WAY
M. : ,
SITE ADDRESS 3q09-0 I^" ICON S-
ASSESSOR'S TAX/PARCEL # — -
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
Winch sqp -aLe pag%f- LMOW 1.94 de -10doW
PROJFCT INFORMATION
jP5 -1(2 13 -4
SFMFCO ME ELPLDEE
SUITE /UNIT #
LOT SIZE (sfl
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ZLECTRICAL ❑ ENGINEERINGFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this peratit or y1
LOW YQLrAGe," T. T . r42 sa uR rrsrcm g!
AREA DESCRIPTION
EXISTING
SQ.FT.
PROPOSED
SQ. FT.
TOTAL
SQ. FT.
BASEMENT
SUMPS
WASHING MACHINES
URINALS
FIRST
N �t SnO s
DRINKING FOUNTAINS
r✓ �� S00 r .
SECOND
❑ YES
HOSE BIBBS
ZONING DESIGNATION
THIRD
CHANGE OF USE?
❑ YES
FOURTH
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
UP /SEPA/SU?
ADDITIONAL FLOORS (DESCRIBE)
o NO
PLATTED LOT? ❑ YES ❑ NO
DECK(COVERED ?)
❑ YES
o NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
aae�rna
nor
roar
row sners�oer+'����
'*NEW HOMES ONLY'" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
type of f fixture to be installed or relocated as part of this project Do not
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS
BBQS FANS
BOILERS FIREPLACE INSERTS
COMPRESSORS FURNACES
DUCTS GAS PIPE OUTLETS
BATHTUBS (-Ti b /Sho Comb.)
SHOWERS
DISHWASHERS
SINKS
GAS PIPE OUTLETS
SUMPS
WASHING MACHINES
URINALS
LAVS mmh,00m stww)
VACUUM BREAKERS
to remain.
GAS LOGS
REFRIG. SYSTEMS
HOODS (commemW
WOODSTOVES
RANGES
MISC (Describe)
GAS WATER HEATERS
❑ REPAIR ❑ TENANT MOVEMENT
WATER CLOSETS ( um t)
MISC (Describe)
DRINKING FOUNTAINS
RAINWATER SYST
❑ YES
HOSE BIBBS
ZONING DESIGNATION
ELECTRIC WATER HEATERS
I cerft under penalty of perjury that the itlformation furnished by me is true and correct to the best of my knowledge, and further, that I
am authorised by the owner q f 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 ciainy, which may be made perso including the undersigned, and filed against the City of Federal Way, but only where such claim
any
arises out gfthe reliance of ud gfficers and employees, upon the accuracy of the information supplied to the city as a part of
this application. p � ,/ (or
NAMIE /TITLE Jam 1{O - ' 1 DATE 0643
(S)gq re) tie)
RELATIONSHIP O PROJECT ❑ Owner ❑ Agent Ox—,(!�ontractor ❑ Architect ❑ Other
Bulletin #100 - January 7, 2005 Page 2 of 4 k\HandoutsTermit Application
❑ NEW ❑ ADDITION
o ALTERATION
❑ REPAIR ❑ TENANT MOVEMENT
BUILDING SM LI. ONLY? OYES ❑ NO
BASIC PLAN?
❑ YES
n NO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
a NO
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
UP /SEPA/SU?
❑ YES
o NO
PLATTED LOT? ❑ YES ❑ NO
DE1a90 PRRNMT REQUIRED?
❑ YES
o NO
Bulletin #100 - January 7, 2005 Page 2 of 4 k\HandoutsTermit Application