06-106391My Of A,
Federal Way
COMMUNITY DEVELOPMENT SERWC,
33325 8- AVENUE SOUTH - Po BOX 9
FEDERAL WAY, WA 98063.9718
253.835 -2607- FAX 253-835 -2609
www eftyoll'ederalway eom
RECEIV
DEC 2 p 20 6
RITY aF FF.DERAL WAY `-' RMIT
BUILDING PPLI CATI O N
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SF MF CO ME EL PL DE EN FP
SITE ADDRESS ' ' '�•
SUITE /UNIT it G O
ASSESSOR'S TAX /PARCEL # S z q S- O 0 'q 0 LOT SIZE (sj) S-7
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) _ FederC. I li✓Q.V CFOSS;K4 5 8/c G
(Aaaah separate pope f- f-gfhy 7A7W d —pft-q
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING -FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
) 4 t r i� �, + a d P.•, alp., j- /, �.l g ,�c •h L+raf .:<.: s� r , l rb...
PROJECT NAME (Name of Business or Owner Last Name) 4.4 NI,V rlt IG ,�,
PEOPLE •- •
PROPERTY
OWNER
NAME PRIMARY PHONE
MAILING ADDRESS CITY, STATE, ZIP
6 E/ • S a c. 166A_ 984q-7
COMPANY NAME n
Pa, ri F,' e. 1' �ecFtovl vtc.
APPLICANT NAME
CA"" WiISOA
OFFICE PHONE
(25-3) 2,$f- - 3506
MAILING ADDRESS
7, o
CITY, STATE, ZIP
CELL PHONE
.
'FEDERAL
wce .I /A .z
(2 ) -(-05- 71-S�4
CITY OF WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE .=
PAX NUMBER
❑ Architect o Tenant
2' / 31 06
(L6.3) 28Ij- - 3SO7
CONTRACTORS REGISTRATION NUMBER (copy of card regahed with each application)
EXPIRATION DATE
MPANY NAME
APPLICANT NAME
OFFICE PHONE
Fhe-
�. L•✓1,&0A
(2,S3 ) 2-1&4- - 3so6
MAILING ADDRESS
220 7 0 "'
CITY, STATE, ZIP _
g- Ta (vA e
CELL PHONE
(2-5'5,) 1'05- 74-s-* - 74-s-*
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect o Tenant
❑ Agent o Other (Describe)
. ca►..
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
FIRST
EVAPORATIVE COOLERS
GAS LOGS
REFRIG. SYSTEMS
SECOND
FANS
HOODS (cemmm iq
WOODSTOVES
THIRD
FIREPLACE INSERTS
RANGES
MISC (Describe)
FOURTH
OURNACES
(iA8 WATER HEATERS
ADDITIONAL FLOORS (DESCRIBE)
GAS PIPE OUTLETS
DECK (COVERED ?)
GARAGE O CARPORT 0
SHOWERS
WATER CLOSETS 0630
MISC (Describe)
NUMBER OF FLOORS
cxtsraa
raorosco
-;.:
TOTAL
__..
`•.RU .....,.W.�Fy
Imp.,
., .:.
` "NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
WASHING MACHINES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to
MECFiAMCAL
Value of Mechanical Work $
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS LOGS
REFRIG. SYSTEMS
BBQS
FANS
HOODS (cemmm iq
WOODSTOVES
BOILERS
FIREPLACE INSERTS
RANGES
MISC (Describe)
COMPRESSORS
OURNACES
(iA8 WATER HEATERS
DUCTS
GAS PIPE OUTLETS
PLUAWNG
BATHTUBS (arTib /sh*mrc=bq
SHOWERS
WATER CLOSETS 0630
MISC (Describe)
DISHWASHERS
SINKS
DRINKING FOUNTAINS
GAS PIPE OUTLETS
SUMPS
RAINWATER SYST
WASHING MACHINES
URINALS
HOSE BIBBS
LAVE
VACUUM BREAKERS
ELECTRIC WATER HEATERS
I eert(fy 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 Fie RA4 _witich.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.
NAMR /TITLE ' (�irn�.
(Signature(
RELATIONSHIP TO PROJECT a Owner o Agent Contractor
DATE 12-- Zo — O, i
t uual
❑ Architect ❑ Other
Bulletin # 100 — January 7, 2005 Page 2 of 4 k\HandoutsNPennit Application