Loading...
05-105176r� RECEIVED OCT 0 6 200", My OF CITY OF FEDERAL WAY Federal Way PERMING DEPT, COMMUNITY DEVELOPMENT SERVICES 33325 FEDERVENUE SOUTH 980 O 971 9718 APPLICATION FEDERAL WAY, WA 98063 -9718 253 - 835 -2607• FAX 253 -835 -2609 www.cftuoffederalwau.mm is SITE ADDRESS ASSESSOR'S TAX /PARCEL # - an incomi2tete ffQQjjaQd9n will not be PROPERTY •. • a -114A-T" s %QCET LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) Wt h separate Pavel fnwft gal descHPnau PROJECT • • r mg 8 6 5 - j- o—� L -1 SF MF CO ME EL PL DE E P TD oted. Please Drint leaiblu !in ink) or tune. SUITE /UNIT # LOT SIZE (s f) TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING OR FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu) NEUJ FS2C ALASZrrN SYSTEM t()O %f-, Cc»�tzACaE W ---tH ALA- IowiKr'(.tC t7K- (eC- -110 ) mANuP 2UL.L S-iA-rT 3WS PV-T EV ITS A"Q mcwNI lorza,u6� 15F SjQFm , IALLAT:100 -k�Y ELFcia1CAL- ( C 0-), AC'02 PROJECT NAME (Name of Business or Owner Last Name) /i V Si /� S R L.y SS S �� ►.S�C� PEOPLE •• • PROPERTY OWNER CONTRACTOR APPLICANT CONTACT LENDER NAME PRIMARY PHONE PHONE CzTAT1:ci)J mRNhc,rrneu i (zs3) A -3 1-3 MAILING ADDRESS CITY, STATE, ZIP S31 - 'AC --fIc- NAIQ �IWA 6% FTFC W '78 Ll Zii CITY, STATE, ZIP ICU VA LLLLP W A 1?8 STS CELL PHONE (Z53) 4p51 - 010 0c( RELATIONSHIP TO PROJECT ❑ Architect ❑ Tenant ❑ Agent [y Other (Describe) Cc�I..s-i V-ACZ/2Z FAX NUMBER (-2 3) �l�lo - 5gt-A COMPANY NAME APPLICANT NAME OFFICE PHONE t><R(7-Q sy.sA -ne s LLB o MA" W AS (as3) 84(1- Sy ©o MAILING ADDRESS CI , STATE, ZIP CELL PHONE O. 731 ' `T �V Au uo LoA M371 VcO (4,91 -alo c9 CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER O -off - 1 2 3 F3 1 -B (a /31 /05 USI)84(r -SNvg o% '1 L CONTRACTOR'S REGISTRATION NUMBER (copy of card required with each application) EXPIRATION DATE ESQCU. As 143ZR al /I9 /010 COMPANY NAME APP ICANT NAME PHONE E- SQUA(-6 �LG sysrEmS 60 MA AdZ (25�) � �� - S�� MAILING ADDRESS 1P n l -73 i '2 2'T CITY, STATE, ZIP ICU VA LLLLP W A 1?8 STS CELL PHONE (Z53) 4p51 - 010 0c( RELATIONSHIP TO PROJECT ❑ Architect ❑ Tenant ❑ Agent [y Other (Describe) Cc�I..s-i V-ACZ/2Z FAX NUMBER (-2 3) �l�lo - 5gt-A NAMP--, PRIMARY PHONE E -MAIL ADDRESS K ©o MA'*y Pk(LP (253) �yto- `4D f'o Q cuM ,leer• ROW 19.27. 095: Lender information is NAME Sf' mquir d (f project value exceeds $5,000 [ Q C.101L. MAILING ADDRESS CITY, STATE, ZIP DETAILED BUILDING INFORMATION l � EXISTING USE PROPOSED USE %f�{ EXISTING ASSESSED /APPRAISED VALUE $ Y - VALUE OF PROPOSED WORK $ % O ✓ �' d SPRINKLERED BUILDING? RYES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES >MC*0 WATER SERVICE PROVIDER XLAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) SEWER SERVICE PROVIDER LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC) AREA DESCRIPTION EXISTING S . FT. PROPOSED SQ. FT. TOTAL SQ. FT. BASEMENT FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS (DESCRIBE) DECK (COVERED ?) GARAGE ❑ CARPORT ❑ NUMBER OF FLOORS �87siO eaoros® corm rarma ar mrm rxoroeav sr mr•• ^_ " *NEW HOMES ONLY"* NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. Value of Mechanical Work AIR HANDLING UNITS BBQS BOILERS COMPRESSORS DUCTS BATHTUBS (or Tub /Shower Combo) DISHWASHERS GAS PIPE OUTLETS WASHING MACHINES LAVS (Bathroom Sinks) EVAPORATIVE COOLERS FANS FIREPLACE INSERTS FURNACES GAS PIPE OUTLETS SHOWERS SINKS SUMPS URINALS VACUUM BREAKERS GAS LOGS HOODS (Corm mial) RANGES GAS WATER HEATERS WATER CLOSETS (rotiet) DRINKING FOUNTAINS RAINWATER SYST HOSE BIBBS ELECTRIC WATER HEATERS REFRIG. SYSTEMS WOODSTOVES MISC (Describe) MISC (Describe) I certtjy 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 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 information supplied to the city as a part of this application. NAME /TITLE �U DATE (Signature) Mile) RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent A Contractor ❑ Architect ❑ Other Bulletin #100 - January 7, 2005 Page 2 of 4 k\Handouts\Permit Application