06-105665Wtro, �"^►.."�
Federaf Way RECEIV DpERMIT
COMMUNrIY DEVELOPMENT SERVICES
3332E 5 ERAL WAY, WA9Sp63- �1g97J8 NOV ao, P LI CATI O N
•253 -835 -2607• FAX 253-835 -2609
www. di ttof federal wa ti. eom
CITY OF FEDERAL WAY
The following is requiEWftqW*&K4xTpm incomplete application will not be
SF MF CO ME EL PL DE EIJ(:Fj)
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ted. Please print legibly (in ink) or tune.
SITE ADDRESS
T� - 1 �✓ , SUIT /UNIT #
ASSESSOR'S TAX /PARCEL LOT SIZE (si
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) 111 -t—
(Attach separate pope for lengthy legd d-- fptlon)
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ IRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this Hermit oalul
PROJECT NAME (Name of Business or Owner Last Name)
• •- •
PROPERTY -E4UF+
WNER _ PRIMARY PHONE
t 1 MAILING ADDREW CITY, STA , ZIP-
CONTRACTOR
r
APPLICANT
COMPANY NAME
APPLICANT NAME
APPLICANT NAME
OFFICE PHONE
C AT ZIP
PHONE
-
I G RESS
,. P7,
C17y, ST T
CELL PHONE
CITE OF'FEDERAL
Y USINESS L[CL 3E NUMBER D TE
FAXCNUMBER
1 Q L $'L
CONTRACTOR'S REGISTRATION NUMB (eop of card required with each applicatioul
-AXPIRATION DATES
/ f'I lj Tr
COMPANY NAME
1
APPLICANT NAME
OFFICE PHONE
� -
I O SS
C AT ZIP
PHONE
/CELL
-
'RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe)
_
EXISTING I PROPOSED
FIRST
TOTAL
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED ?)
GARAGE 0 CARPORT ❑
NUMBER OF FLOORS E7IIStWO PROPOSED TOTAL
"NEWHOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to
0 1
MECELANICAL
Value of Mechanical Work $
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS LOGS
REFRIG. SYSTEMS
BBQS
FANS
HOODS (Commereiaq
WOODSTOVES
BOILERS
FIREPLACE INSERTS
RANGES
MISC (Describe)
COMPRESSORS
FURNACES
GAB WATER HEATERS
DUCTS
GAS PIPE OUTLETS
PLUMBING
BATHTUBS )or Tub /shower Combo)
SHOWERS
WATER CLOSETS
MISC (Describe)
DISHWASHERS
SINKS
DRINKING FOUNTAINS
GAS PIPE OUTLETS
SUMPS
RAINWATER SYST
WASHING MACHINES
URINALS
HOSE BIBBS
LAVS ie.O.su&4
VACUUM BREAKERS
ELECTRIC WATER HEATERS
I cer ft 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 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 Wormation supplied to the city as a part of
this application. � Z
NAME /TITLE I� Pi��f- M"Abr DATE
` (Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent Contractor ❑ Architect ❑ Other
0
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Bulletin #100 — January 7, 2005 Page 2 of 4 LAHandoutsTelmit Application