06-105021Federal Wa PERMIT
COMMUJUTYDEVELDF%1ENrSERVIQ$f'� O
333258WAVENVE
AY, WA iI • P -9718 PLI CATI O N
FEDERAL WAY, WA 88063 -9718
253 - 835-2607• FAX 253-835-2609
www.cituoffederaiw .m
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The following is mea "infnrmatton - an incmnvtete anolication will not be
LEGAL DESCRIPTION (e.g. Aane Estates. Lot 1)
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SF MF CO ME EL PL DE EN P
t)ted. Please mint legibly (in ink) or tune.
Sr/UNIT 0 -�
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TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING >(FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this Permit onlu)
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PROJECT NAME (Name of Business or Owner Last Name)
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
NAME PRIMARY PHONE
MAUJN ADDRESS I CITY, 1E, ZIP
/3 w L
COMPANY NAME
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APPLICANT NAME
APPLICANT NAME
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OFFICE PHONE
(2C6)
7Z /
MAII.ING ADD
3a/3 3'�'�4v�
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe)
CITY. STATE, Z3P
fTU_� t v� F,1 G
CELL PHONE
(9M -0oZ -7Z-r9
CITY OF FEDERAL WAY BU LICENSE NUMBER
Z 0 - 0 O - / D
EXPIRATION DATE
FAX NUMBER
(Zs 3) 7X'9
- OLS4
B
R'S RF�I,.'L N.R. NUMBER (� � � with each pi�catloy)
EXPif2AT70N Ll%1E
/ '
COMPANY NAME
APPLICANT NAME
/OFFICE PHONE
l ) -
MAO-ING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe)
FAX NUMBER
( ) -
PRIMARY PHO i/ T.L'U� ✓ / /GG�/7Gi� ( ) G5Z - 7Z:5- � E- MAU,ADDRESS
Pier RCW I9.27.095. Lender bWwmathm is
required (fprtfx vahw Owego $6.000
NAME
MAUING ADDRESS
CITY, STATE. ZIP
PHONE
PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $��
SPRINKLERED BUILDING? ❑ YES ❑ Pq FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAREIIAVIW ❑ HIGHIMM ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER 0 LAMMAVBN ❑ HIGIMMM ❑ PRIVATE (SEPTIC)
a4
1
AREA DESCRIPTION
FJaB MG
89, FT.
PROPOSED
SQ. FT.
TOTAL
SQ, FT.
BASEMENT
a NEW o ADDITION
a ALTERATION
a REPAIR a TENANT
FIRST
EVAPORATIVE COOLERS
GAS LOGS
REFRIG. SYSTEMS
SECOND
FANS
HOODS (comme,do
WOODSPOVFS
THIRD
FIREPLACE INSERI'S
RANGES
MISC (Describe)
FOURTH
FURNACES
GAS WATER HEATERS
UP /SEPA/SV?
ADDITIONAL FLOORS (DESCRIBE)
GAS PIPE OUTLETS
PLATTED LOT? a YES a NO
DECK(COVERED ?)
a YES
D NO
GARAGE O CARPORT ❑
SHOWERS
WATER CLOSETS (roue)
MISC (Describe)
NUMBER OF FLOORS
roomm
lox"
20MOSIRMW
2UMPeaecermo
peree
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
of each 41pe ofjixture to be installed or relocated as part of this project Do not include extst&W jiztures to remain.
AfzX;rAAN1 rw
Value of Mechanical Work $
a NEW o ADDITION
a ALTERATION
a REPAIR a TENANT
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS LOGS
REFRIG. SYSTEMS
BBQS
FANS
HOODS (comme,do
WOODSPOVFS
BOILERS
FIREPLACE INSERI'S
RANGES
MISC (Describe)
COMPRESSORS
FURNACES
GAS WATER HEATERS
UP /SEPA/SV?
DUCTS
GAS PIPE OUTLETS
PLATTED LOT? a YES a NO
PLUMBING
a YES
D NO
BATHTUBS (-7Ub /Shower Combo)
SHOWERS
WATER CLOSETS (roue)
MISC (Describe)
DISHWASHERS
SINKS
DRINKING FOUNTAINS
GAS PIPE OUTLETS
SUMPS
RAINWATER SYST
WASHING MACHINES
URINALS
HOSE BBBS
LAVS Maui SmkQ
VACUUM BREAKERS
ELECTRIC WATER HEATERS
I cent ft under penalty gf perjury that the irI%rmation furnished by me is true and correct to the best gf my knowledge, and further, that I
am authorized by the owner of the above premises to perform the wow ke for which the permit application is made. I further agree to hold
harmless the City of Federal Way as to any claim f{neluding costs, expenses, and attorneys-fees, incurred in the investigation and delfense of
such claimd„ which may be made by any person, including the undersigned, and jlled against the City gf #federal Way. but only where such dafm
arises out of the reliance of the dty, tncluding its )dicers w employees, upon the accur=* M' the fr}jbrmation supplied to the city as a part gf
this application. / / Z
NAME /TITLE �.� _ DATE /U U
RELATIONSHIP
— v MUM
❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
a NEW o ADDITION
a ALTERATION
a REPAIR a TENANT
BUILDING SHELL ONLY? a YES ONO
BASIC PLAN?
D YES
a NO
ZONING DESIGNATION
CHANGE OF USE?
a YES
a NO
NEW ADDRESS REQUIRED? a YES o NO
UP /SEPA/SV?
a YES
a NO
PLATTED LOT? a YES a NO
DMO PER1nT R3gU1RXD?
a YES
D NO
Bulletin #100 — January 1, 2006 Page 2 of 4 MandoutsTernut Application