06-103469R E C E � Fl AL - 1 O Z Ne;'eralway PERMIT
OQAWX 9YDSVJMWAM RrSSR19CZS „ j SF MF CO ME EL PL DE EN P
9992 AVBU PDX 9718 13 mn
FM) BdWAY, WA- 98 063A718
259. 835• 2607• FAX 259.8354609 _ p P LI C AT I O N
www.dtw/kdem1way.wm C TV OF FEDERAL WAS'
e�
ILDING DEPT.
The ollowin is re ire in ormation - an ingeMelete application will not be accel2te d. Please rant legibly n inkLo_rtpqj
PROPERTY •- •
SITE ADDRESS / 14 / 4 S 3 Z,y Tf/ SUITE /UNIT t
ASSESSOR'S TAX /PARCEL i / 5 O O O- O 0 8 O LOT SIZE (s•/)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
/ nmd� +ep�kvroefa•+anetiwMrata�oiymaJ
PROJECT •• •
TYPE OF PERMIT ❑ BUILDING . ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING 1kFIRE PREVENTION SYSTEM
PROJECT. DESCRIPTION (Provide detailed description of work included on this permit onlvi
At, ZRC -..v c ATE SP)Z* 1A//,1 LL-f4S FC/t TE7yAiy7- /M P/ZdyE-M f---"7-
PROJECT NAME (Name of Business or Owner Last Name)
PEOPLE •• •
PROPERTY
OWNER
•
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
NAME PRIMARY PHONE
dIZSG /r!l /ESTM1= N'j" r�2oPt�'i7 /c3 • LL �.
1.(14ZS) 556 - 9000
MAILING ADDRESS CITY, STATE, ZIP
/-? >/o Al,-- zoTN S7- A #-q6DJ a&-tL&-voE, vvA 98OO5
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
/' - r/L /o-r F /2E— I: o- r,- mr /.A/
(Z7r3) 'TZ6 - ZZ ?O
MAILING ADDRESS
CITY, STATE, ZIP
-r-Acory4 W4
CELL PHONE
S`O'S - 0763
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
C) 1 R e 8 -B
L /Z / 3/
CONTRACTOR'S REGISTRATION NUMBER )eopy of card regcired with "ch appReatlon)
EXPIRATION DATE
A 7' F'P o 9 4 c
F
/Z / 3! l 06
COMPANY NAME L
APPLICANT NAME
OFFICE PHONE -
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE'
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑: Tenant
o Agent. ❑ Other (Describe)
( ) . -
LISTING ASSESSED /APPRAISED VALUE $_
SPRINKLERED BUILDING? RYES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN
SEWER SERVICE PROVIDER ❑ LAKEHAVEN
PROPOSED USE Q�'Cl4Tk -�OGI
VALUE OF PROPOSED WORK $•
FIRE SUPPRESSION SYSTEM PROPOSED %REQUIRED? ❑YES 14NO
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ HIGHLINE ❑ PRIVATE (SEPTIC)
0
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
SO. FT.
TOTAL
S . FT.
BASEMENT
FIRST
`505 -1
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK(COVERED ?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
tcosrero
raoroesa
rotN.
"NEWXOMGS ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
number of each type of facture to be installed or relocated as part of this project. Do not include existing
Value of Mechanical Work $
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS J.T.b /sbea --bO
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS p.&. wwo
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
_T SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
-HOODS (C.mmerctq
RANGES
GAS WATER HEATERS
WATER CLOSETS n'oseq
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I cert(fy under penalty of perjury that the b{formation 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 flied 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
U (stgneture) t„uaq
RELATIONSHIP TO PROJECT a Owner O Agent Contractor I] Architect O' Other
'1 -13- oc-
0
Bulletin #100 — January 1, 2006 Page 2 of 4 MandoutsTermit Application