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06-106092t•.4 'ITY OF Federal Way REOEIVW PERMIT COMMUNIT) DEVELOPMENT SERVICES 33325 81" AVENUE SOUTH • BOX 97]NOV 3 0 ��, p L I C ATI O N FEDERAL WAY. WA 98063 63 -9718 253 - 835 -2607• FAX 253 - 835 -2609 }awu_.cttWffederalwa1co11tCITY OF FEDERAL WAY - l o off? SF MF CO ME EL PL DE ENO SITE ADDRESS _ _ ( _ l I -10- SUITE /UNIT # L [ o L ASSESSOR'S TAX /PARCEL # ? C - LOT SIZE (sf LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) (Attach separate page, j lengthy legal descripttan) PROJECT • • TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING eFIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on tits permit onlu) M 5-w -e z: a tc W A90, o n ",) G< SL 0 PROJECT NAME (Name of Business or Owner Last Name) 60 W, Arc" SS PEOPLE •• • PROPERTY OWNER CONTRACTOR CONTACT LENDER EXISTING USE NAME PRIMARY PHONE OPQS aw I-LC- (425 )qS3 -'f(oo MAILING ADDRESS CITY, STATE, ZIP COMPANY NAME PAC-xi-T--:c F, 5�-; APPLICANT NAME �.ts;M, OFFICE PHONE (�) 788 -380(, CELL PHONE ( ) - RELATIONSHIP TO PROJECT in�t ❑ Architect ❑Tenant ❑Agent ❑Other (Describe) Gill- i (2 O(o) -7z(, - $j (00 MAILING ADDRESS SZS PaPLAiL 'S. CITY, STATE, ZIP S6a-l7L r-- LtA qg,,Vq CELL PHONE ( ) - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER Z 0- 2 - / 0 5 Lf 9 2-B / (12,04 ) 7Zb - P400 _© L REGISTRATION NUMBER (copy of card required with each application) EXPIRATION DATE /CjONTRACTOWS A C t C F 9- 7- 3 2" /6 ISO /107 COMPANY NAME ( A I FtL I uL APPLICANT NAME Tel 15;4sTM4%/ OFFICE PHONE (06(.) 7 8? - 3$06 MAIL) NG ADDRESS R M AqA ouz A**- CITY, STATE, ZIP S- sAgTt -e wA %IYY CELL PHONE ( ) - RELATIONSHIP TO PROJECT FAX NUMBER ❑ Architect ❑Tenant ❑Agent ❑Other (Describe) Gill- i (2 O(o) -7z(, - $j (00 NAME PRIMARY PHONE E ADD a MAILING ADDRESS NAME CITY, STATE, ZIP PHONE EXISTING ASSESSED /APPRAISED VALUE $_ SPRINKLERED BUMDING? ❑ YES ❑ NO WATER SERVICE PROVIDER ❑ LAKEHAVEN IlHIGHLINE SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE PROPOSED USE vAL= OF PROVO4M WrOM SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO TACOMA ❑ PRIVATE (WELL) AREA DEBC ION EXISTING . FT. PROPOSED 89. FT. TOTAL 8 . FT. BASEMENT EVAPORATIVE COOLERS BBQS FANS FIRST E FIREPLACE INSERTS COMPRESSORS FURNACES SECOND GAS PIPE OUTLETS THIRD FOURTH ADDITIONAL FLOORS (DESCRIBE) DECK (COVERED ?) GARAGE ❑ CARPORT ❑ NUMBER OF FLOORS M-- r■oroam rorsc■:nr xoW m Znwroswar MAL "NEW HOMES ONLY"* NUMBER OF BEDROOMS MATED SELLING PRICE $ Indicate number of each type of fGrture bo be installed or relocated as part o thts project Do not include ex(st(ng ftvti r to remain. MECUANICAL Value of Mechanical Work $ AIR HANDLING UNITS EVAPORATIVE COOLERS BBQS FANS BOILERS FIREPLACE INSERTS COMPRESSORS FURNACES DUCTS i GAS PIPE OUTLETS BATHTUBS MACHINES LAVS SHOWERS SINKS SUMPS URINALS VACUUM BREAKERS GAS LOGS HOODS! \m RANGES \, GAS WATER WATER CLOSETS DRINKING FOUNTAINS RAINWATER SYST HOSE BIBBS ELECTRIC WATER HEATERS REFRIG. SYSTEMS WOODSTOVES MISC (Describe) MISC (Describe) I certify under penalty of perjury tha the igformation furnished by me is true and correct to the best of my knowledge, and further, that 1 am authorized by the owner of the premises to perform the work for which the permit application is made. I further agree to hold harmless the City of Federal 4jWay ny claim (including costs, expenses, and attorneys' fees incurred in the investigation and defense of such claim), which may be m n, including the undersigned, andfiled against the City of Federal Way, but only where such claim arises out of the�ti�nce o udtng its gQicers and employees, upon the accuracy of the igformation supplied to the city as a part of this annlicatipf. NAMB/TITLE —/U/11 U %L /.<Ii!�� RELATIONSEVTOPROJECT DOwner DAgent Mile) Contractor ❑ Architect ❑ Other (L'd(-'d', Bulletin #100 — January 1, 2006 Page 2 of 4 k\HandoutslPennit Application