06-104023�.�.' , RECEIVED
�d��w� :. PERMIT
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96ddJS ?607FAX ?6Jd36460�'TM OF FED R L 1/1/fjy
BUILDING DEPT.
FI
SITE ADDRESS Ll
ASSESSOR'$ TAX /PARCEL # . S_ a_Q7
LEGAL DESCRiPTIO &.9, Acme Estates; Lot IJ /`- �-nc�.a C—
lAa°dugwaw~f- l de«rfPaW
SF MF CO ME EL PL DE RN F
SUITE /UNIT # 1 t O —
// L—O^T SIZE (s fl
TYPE- OF•PERMPP ❑ BUILDING . ❑ PLUMHING ❑ MECHANICAL
❑ DEMOLITION a ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT. DESCRIPTION (Pi+ntilde detailed des tlon of wor ite[ucled'on this 2d�t:�jwj �ZA >
, `o d'h Ole— We
SU4 vrte
PROJECT NAME (Name ofBuslness or Owner Last Name)
PROPERTY
OWNER
..NAME
N� %
PRIMARYPHONE
L `
MAILINOA DRESS
CITY, STATE ZIP
Ll.
CONTRACTOR
COMPANY NAME
y� �!
APPLICANT NAME
(OFF�FICE PHONE
MAILMO ADDRESS
�. PO 14- Ame, S.
Cam' ST P
5 � �.. q��
CELL PHONE
r _
CITY OF FED RAL'WAY BUSINESS LICENSE NUMBER
EXPIRATION BATE
FAX MBE$
CQONTRACTORS REGISTRATION NUMBER jeopy of card`required with egch tppUe On
L G 7
r S Y% P
EX PIRATION DATE
- - - - -=
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APPLICANT
PANY ME i
MM / f
APC�ANT N
OFFICE PHONE '
MAILING AD ES S
CITY, STATE 21P
�o O
CELL PHONE" '
PAIt°' ���
REIATIONSHI . TO PROJECT
p Architect a Tenant ❑ Agent (3 Other (Describe) (1
PAX NUMBER
c/6 ) ?)�l - at6U
CONTACT
NAM
PRIMARY PHONE
E- MAILADDRESS
-%
LENDER
to be iristalied or relocated as part of this project. Do not inclade existing fUNF1es to-
MHCffAArICAL
Value of Mechanical Work
SHOWERS
AIR HANDLING UNITS
EVAPORATIVE COOLERS
BBQS
FANS
BOILERS
FIREPLACE INSERTS
_...,.._......COUPRE55M
FURNACES
DUCTS
GAS PIPE OUTLETS
CT
BATHTUBS (or Tub /shower Combo(
SHOWERS
DISHWASHERS
SINKS
GAS PIPE OUTLETS
SUMPS
WASHING MACHINES
URINALS
LAVS r affi om sh"
VACUUM BREAKERS
GAS LOGS REFRIG. SYSTEMS
HOODS (Commerdan WOODSTOVES
RANGES MISC (Descnbe)
GAS WATER HEATERS
WATER CLOSETS jloileQ 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 7
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 ft led against the City of Federal Way, but only where such claim
arises out ojthe reliance of the pity, including i officers and employees, upon the accuracy of the Information supplied to the city as apart of
this application. n
NAME /TITLE) �f /6/ DATE
(Sim , (Title)
RELATIONSHIP TO PROJEC - Q Owner a Agent '6 6ontractor 0 Architect ❑' Other