05-106156RECEIVED
DEC 0 2 2005
cRr ar
Federal Way PE RMPP OF FEDERAL WppYY
COMMUNITY ITVELOPNENT SERVICES BUILDING DEPT. -SF MF CO ME EL PL DE EN
33325DERAL UESONIH•POBOX9718 APPLICATION
FEDERAL WAY, FAX 98063 -9718
253 - 8352607• FAXT53- 835.2609
ww w. n f wifiederahua u. rum
a - r 77..,.4.•.. 7e ro.rrarba ir.f .- .....ra.... -..� will net he ac eatid. Please arint Ieo16Iv tin ink) or tune.
SITE ADDRESS j -o arcrr —�'�i �w�'2Z 5 J 3�i (A �? v) SUITE /UNIT#
ASSESSOR'S TAX /PARCEL # _ _ _ _ _ - _ _ _ _ LOT SIZE (sn
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
IAaoch separaw pogofur WWhy legal dexcr ..)
E PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING O PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING XFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
Wl G '%"s e^s LA i ( m6b 1 TaC.l st s;ixfen, rrf;L -* +kA- e,60-r+
Q% T u�il ax 7-1• SFS I s +a'1 "d'y- e.* •K*C Cx -.at" . 11- is sDci�kf-
�T
JnY�_s�G� 'I'O 14 16Laf+g trn.+lw 1
PROJECT NAME (Name of Business orOwner Last Name) c-' Fio-k Le
PEOPLE ••
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
EXISTING ASS,
NAME PRIMARY PHONE
-6f- ato( � tsI ?.�vcstlrS ( )
MAILI ADDRESS C ,STATE, ZIP
COMPANY N
Rice, 5
NAME j
T NAME
:36-1,, �� 1h er�e*dl
OFFICE PHONE
(zT3 ) 9a4
- Ireb
isit VA-s
MAILING ADDRESS I
j o 19 — �I t'� Ave- E
CITY, STATE, ZIP
wd Lq
CELL PHONE
( )
CRY OF FEDERAL WAY BUSINESS LICENSE NUMBER
-1
EXPIRATION DATE .
le2 l 3 l /6
NUMBER
)Ialo
1 9 -8 -0 o Q Q T s -B L
CONTRACTORS REGISTRATION NUMBER (copy of card required with each APP•ic•tiou)
EXPIRATION
p/ as
DATE
/O(j
5 M z -- g F z 13 k
Q-1
NAME PRIMARY PHONE E -MAIL ADDRESS
ps'3 19.9 i - ) rrD
PCr RCW 3'$3`I.Q95: Lerutar'iejo - is
NAME j
td#1 ired`i3
MAILING ADDRESS
CrIY, STATE, ZIP
VALUE
SPRINELERED BUILDING? RYES 0 NO
WATER SERVICE PROVIDER XLAKEHAVEN
SEWER SERVICE PROVIDER 'k LAKEHAVEN
PROPOSED USE G
/
VALUE OF PROPOSED WORK
FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? 0 YES )'NO
0 HIGHLINE 0 TACOMA 0 PRIVATE (WELL)
D HIGHLINE 0 PRIVATE (SEPTIC)
AREA DESCRIPTION
EMSTING
. FT.
PROPOSED
S . FT.
TOTAL
S
BASEM T
WOODSTOVES
FIREPLACE INSERTS
RANGES
FIRST
FURNACES
GA8 WATER HEATERS
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE(
DECK(COVERED ?(
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
°pm°0
r"or06°
LL
7arAcsasmasr
rorAt ntro®ss
rpt" °
"NEWHOMES ONLY" NUMBER OF BEDROOMS � E:bqMATED SELLING PRICE $
Value of Mechanical Work
AIR HANDLING UNITS
BBQS
BOILERS /
COMPRESSOR/
DUCTS
.s1
rim
forT b /Shower COmbq
GAS PIPE OUTLETS
WASHING MACHINES
LAVS iB.ffi— ... shoal
or relocated as part of th1sproject. Do not include existing fixtures to remain.
EVAPORATIVE COOLERS
GAS LOGS
REFRIG. SYSTEMS
FANS
HOODSICO rddl
WOODSTOVES
FIREPLACE INSERTS
RANGES
MISC (Describe)
FURNACES
GA8 WATER HEATERS
GAS PIPE OUTLETS
SHOWERS
WATER CLOSETS Ro&q C (Describe!
SINKS
DRINKING FOUNTAINS
SUMPS
RAINWATER SYST
URINALS
HOSE BIBBS
VACUUM BREAKERS
ELECTRIC WATER HEATERS
I certify 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 authorised by the owner of the above premises to perform the work for which the permit application is made. I jLrther 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 ciaimJ which may be made by any person, including the undersigned, and flied 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 DATE I°Z 2 Q
t ignawrel mile)
RELATIONSHIP TO PROJECT ❑ Owner Agent ❑ Contractor 0 Architect O Other
Bulletin #100 — August 19, 2004 Page 2 of 4 k\HandoutslPermit Application
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