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07-103413ar,oF� Federal way -WN 2 2 2oV PERMIT Co mMUNnYDEYEwPMENrEERv1,d 33325 8" AVENUE SOUTH • PO BOX 9718 FEDERAL WAY, WA 5343 7�y OF BUILDING DE P P LI C ATI O N 253- 835.2607• FAX 253-83 i( www, diem ederalwau mm The.followina is - an incomplete application will not be O -Z -�03 SF MF CO ME EL PL DE EN/fP- D / — / L��] cepted. Please print leaibiu /in mid or fw. SITE ADDRESS ' ID TM S+ SUITE /UNIT f ASSESSOR'S TAX /PARCEL # 0 - O LOT SIZE (s� LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) _ ye,,-.- (Attach 6eP —ftPV9 f- A-9dw kga(d- -iptlmq PR07XT INFORMATION TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING K'IRE PREVENTION SYSTEM PROJECT 1DESCRIPTION (Provide detailed/dlescription of work included on this permit onlu) - eKa►a i/' ., ;�l�fn [1; , /+�►¢r e� Q�+r t=- F-t,.� �/�v`z{ty� .� 1ti8� r � S + .. �, k 5 J�o't� • S �lr,.e: e PROJECT NAME (Name of Business or Owner Last Name) I [ Q V. j j v t / It S S - CONTRACTOR CONTACT LENDER EXISTING USE COMPANY NAME w-s 1--, Sk/ f5 ryc �¢. APPLICANT NAME 4-wl -e , c-L-, �4— OFFICE PHONE (tr zr) n 1 -0100 MAILING ADDRESS C- .o. e CITY, STATE, ZIP f" ww�o I V 4 fto S- 2 CELL PHONE (f7 >$-) 736' - .2a 31 CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE . - FAX NUMBER 12/3/ / o-7 (yes lf$1 -3030 NTRACTORS REGISTRATION V4 E S t NUMBER (copy of card required with each appHoatiou) 3& EXPIRATION DATE f- S F 1 Q r _1 /'Z / 31 / el COMPANY NAME qk F\-e APPLICANT NAME AJ-k- 644ty' Ju, OFFICE PHONE ('t Z S-) m - ©l ao MAILING ADDRESS 7,o2- (for° 4-e< CITY, STATE, ZIP - CELL PHONE tic ReC G,.4 ?%-C95-2- (� ks -) 33,6 - ;-a 3 RELATIONSHIP TO PROJECT ❑ Architect ❑ Tenant ❑ Agent X10ther (Descnbe) �H k4 c EN- FAX NUMBER ( '(Zj )'6 I - -303 0 U v- PROPOSED USE EXISTING ASSESSED /APPRAISED VALUE )$ VALUE OF PROPOSED WORK i$ -1 10() * '<.# SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTICI number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. Value of Mechanical Work _ AIR HANDLING UNITS _ BBQS _ BOILERS COMPRESSORS DUCTS BATHTUBS (or Tub /Shovmr Combo) DISHWASHERS GAS PIPE OUTLETS WASHING MACHINES LAVS (sati..sww EVAPORATIVE COOLERS FANS FIREPLACE INSERTS FURNACES GAS PIPE OUTLETS SHOWERS SINKS SUMPS URINALS VACUUM BREAKERS GAS LOGS HOODS (comet m.4 RANGES OAS WATER HEATERS WATER CLOSETS (foneq _ DRINKING FOUNTAINS RAINWATER SYST HOSE BIBBS ELECTRIC WATER HEATERS REFRIG. SYSTEMS WOODSTOVES MISC (Describe) MISC (Describe) I cert(& underpenalty of perjury that the igormation 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 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 reliancg,of the city, including its officers and employees, upon the accuracy of the information supplied to the city as a part of this application. �f 11 '�? jJ NAME /TITLE PROJECT ❑ Owner ❑ Agent 2 retractor "LL/ c� Psi DATE 612ol() (Tide[ ❑ Architect ❑ Other Bulletin # 100 — January 7, 2005 Page 2 of 4 k\Handouts\Perinit Application