06-103778•
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IBDBW WAY; WA• 96063.0716 .
96- M3"607• RAX263.66S•9609
JUL 3.1 2006
crryBUOTHAPIT • SF MF CO ME EL PL DE EN P'F
APPLICATION.
Ination - an incomplete appiicatlon will not be acceptecb' Pieass print kgiblP (in ink) or tune
BITEAbDREBS U-) 40
ASSESSOR'$ TAX /PARCEL N-�
LEGAL DESCRIPTION (e.g. Acme .Estates, Lot 1) 4C' Vii_ �s5
. •,�r«�euwwwarde.
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-S1 SIZE s
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_laid r � ��.� /:,: ,_ � .. •
TYPE-OF-PERMIT ❑ HftDINGi . ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING1*= PREVENTION SYSTEM
PROJI0 T`. /DESCRIPTION (Ndoide detailed description of work included n ' {( n( /
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PROJECT NAME (Name of Business or Owner Last Name) (�
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
NI/ LL C
SS
STATE ZIP ' l
MAILING ADDRESS CITY, ST P CELL PHONE
CITY OF FE Q L WAY BUSINESS LICENSE MBER EXPIRATION DATE FAX NUMBER
--C) 7_.: B
CONTRACTOR'S REGISTRATION NUMBER (copy of card•requlred with c,ch application) EXPIRATION DATE
Z, Y F S 4 3 P�/ _ /a / 3v /�?
PANYf ME /
on k
OFFICE PHO E '
MAIUNG Dl
�j` S'
CITY, STATE ZIP `
CELL PHONE "
RELATION TO PROJECT
❑ Architect O: Tenant ❑Agent .
/�
❑ Othi escriGe =(! a:1
r
FAX UMBER
NA
PRIMARY PHONE
E- MAMADI ESS
r;
• s
Indicate, number of each type of fixture to be installed or relocated as part of this'project. Do not
Value of Mechanfcal Work $
AIR HANDLING UNITS
EVAPORATIVE COOLERS
BBQS
FANS
BOILERS
FIREPLACE INSERTS
,CQ- 9PRESSORS
FURNACES
DUCTS
GAS PIPE OUTLETS
PLUMBING
BATHTUBS (.,Tub /sh...,c mbo)
SHOWERS
DISHWASHERS
SINKS
GAS PIPE OUTLETS
SUMPS
WASHING MACHINES
URINALS
LAVS (B.uu.. md, 4
VACUUM BREAKERS
OAS LOOS REFRIG. SYSTEMS
HOODS (cnmmeretat► WOODSTOVES
RANGES MISC (Describe)
GAS WATER HEATERS
WATER CLOSETS (roueq MISC (Describe)
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
I cert(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 .inade, 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 dny 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 apart of
this application. e
NAME /TITLE DATE
gnature) (Title)
RELATIONSHIP TO PROJECT q.O [] Agent O Contractor ❑ Architect t] Other