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FederalWaY JUL 2 0 2406 p��MIT
COMMUNRYDEVEI.OPMENTSERVICES SF MF CO ME EL PL DE EN FP
333258- AVENUE so(m+ • P %7UF FEDERAL A
FED20-83S-2607- RAL WAY, WA 980 ! / /
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The folloudnq is re uired in orrnatlon - an incoMm Iete a lication will not be accerzted. Please rant Ie ibt /in in or
PROPERTY •• •
SITE ADDRESS 3
SUITE /UNIT #
ASSESSOR'S TAX /PARCEL D Z 5— - Q --G -4 0 LOT SIZE (sp
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attadw+epa-W page f -kngft LVW deawipha.)
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING 4,FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
PROJECT NAME (Name of Business or Owner Last Name) �kc 1 Y cwtng
PEOPLE •- •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
NAME PRIMARY PHONE
MAILING ADDRESS CITY, STATE, ZIP
Pr c L IOCf5
COMPANY NAME
PPV�IDT �a-Qx Pa sr�c, �N
APPLICANT NAME
G� cpa t--
OFFICE PHONE
(-L5 � cc2ke - -Z-,-r,
MAILING ADDRESS CITY, STATE, ZIP
Zo`j tom.. Ate. j ..:. LA- `35 t7
CELL PHONE
(, �) CcoCo
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER IRATION DATE
'FAX NUMBER
— - -- - -- — _ _ __B. L / /
�Se, )C12� �C�Sb
CONTRACTOR'S REGISTRATION NUMBER (copy of on" card required with each application) EXPIRATION DATE
i
i !IC-- � :� Y '- O 1 i C
COrPANY NAME APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS CITY, STATE, ZIP
CELL PHONE
Z- '-7b,
(7-5 Zj 4Ao
-�
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe)
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
FANS
BASEMENT
BOILERS
FIREPLACE INSERTS
RANGES MISC (Describe)
COMPRESSORS
FIRST
OAS WATER HEATERS
a0
GAS PIPE OUTLETS
ELECTRIC WATER HEATERS
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED?)
GARAGE ❑ CARPORT ❑
EIQ"IRO PROPOSED TOTAL
NUMBER OF FLOORS
"•NEW HOMES ONLY"* NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of furture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work $
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS LOGS REFRIG. SYSTEMS
BBQS
FANS
HOODS icomme„c;.q WOODSTOVES
BOILERS
FIREPLACE INSERTS
RANGES MISC (Describe)
COMPRESSORS
FURNACES
OAS WATER HEATERS
DUCTS
GAS PIPE OUTLETS
ELECTRIC WATER HEATERS
BATHTUBS (or Tub /shovwrCombo)
SHOWERS
WATER CLOSETS (1'oneq MISC (Describe)
DISHWASHERS
SINKS
DRINKING FOUNTAINS
GAS PIPE OUTLETS
SUMPS
RAINWATER SYST
WASHING MACHINES
URINALS
HOSE BIBBS
LAVS (Bothroomsink,)
VACUUM BREAKERS
ELECTRIC WATER HEATERS
I certify under penalty of perjury that the triformation 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 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 irtformaUon supplied to the city as a part of
this application.
NAME /TITLE _Li %G/7 Q-���T ► lyHu pc�v�I'' DATE I —Z� OC.i
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent Contractor ❑ Architect ❑ Other
1 0 �
Bulletin # 100 — January 7, 2005 Page 2 of 4 k\Handouts\Permit Application