05-103253Federal Way
RECERED
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JUL O O 205 PERMIT SF MF CO ME E�E EN FP
333258*NW WA , WA 9 • PD 971 9718
FEDERAL WAY, WA 98063.9718 /
253- 835 -2607• PAX 2S3.83s- 2609^ITY OF �ED &ABLICATION
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The following is re aired info - an inco Zeta a iication will not be acre d. Please rant to ibi n i or
PROPERTY INFORMATION
SITE ADDRESS 3 5 6 ,,�e CRY .1 %iii iwP�1Q•RC CG�I W4 �AD23 SUITE /UNIT
ASSESSOR'S TAX /PARCEL 1k /V1�/ - (� LOT SIZE (s�
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach - P- 1- pap la knUft kgW dmatpdaN
PROJECT • •
TYPE OF PERMIT ❑ BUILDING )(PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed desavtion of work included on this permit on1W
'fir a�Q�f✓Gc: � �,D Gy�° jL
PROJECT NAME (Name of Business or Owner Last Name) _ < Q Q, OS T E LL E V
PEOPLE •• •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
NAME PRIMARY PHONE
1 p-0",g 11c /Z 0.& fe /-e-,v (25.) oP7-/ - ..909
MAILING ADDRESS CITY, STATE, ZIP
356-17 do �'4*A� �fW Fe-c(e,2a L W kVW 9cP02 3
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP —
CELL PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
CITY OF FEDERAL WAY BUSINESS L[CNSE NUMBER EXPIRATION DATE -:
'FAX NUMBER
— _ _ _ -- B' L.
CONTRACTORS REGISTRATION NUMBER (copy of cud required with each application) EXPIRATION DATE
COMPANY NAME
0
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP —
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Descibe)
( _
AD
�
)/r(
AREA DESCRIPTION EXISTING PROPOSED TOTAL
S . FT. S . FT. S . FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
s
ADDITIONAL FLOORS (DESCRIBE)
DECK(COVERED ?)
GARAGE ❑ CARPORT O
tMSTBfO PROPOSED t07AL ... .. .. . .... .....�!' i � :..
NUMBER OF FLOORS
"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
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS
BBQS FANS
BOILERS _ FIREPLACE INSERTS
COMPRESSORS FURNACES
DUCTS _ GAS PIPE OUTLETS
BATHTUBS (or7Lb /shower Combo)
SHOWERS
DISHWASHERS
SINKS
GAS PIPE OUTLETS
SUMPS
WASHING MACHINES
URINALS
LAVS (Bathroom sto M
VACUUM BREAKERS
GAS LOGS REFRIG. SYSTEMS
HOODS (commemt.q WOODSTOVES
RANGES MISC (Describe)
OAS WATER HEATERS
WATER CLOSETS (roseq MISC (Describe)
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
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 authorized 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 clam, 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 Information supplied to the city as a part of
this application.
NAME /TITLE DATE 7 o6. O
(Signaturel ' mt1el
RELATIONSHIP TO PROJECT p Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other
Bulletin # 100 — January 7, 2005 Page 2 of 4 k\Handouts\Permit Application