07-101270RECENJ
My of MAR 0 9 2007 Q - D-
Federal way PERMIT
CDififuWflYDE'ELOPMENT F FEDERAL W SF MF CO ME EL PL DE EN FP
333258 EF 43 -971M LI CATI O N
FEDERAL WAY, WA 98063 -97I LDINQ DEP p
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Thefollowing is Muiredtaformation-anincomm, fete a lication will not be acce ted. Please rant to ibi rt t or
PROPERTY 1 • • c
SITE ADDRESS S 3 S ,-UNIT #
ASSESSOR'S TAX /PARCEL 11 _ _ _ _ _ - LOT SIZE (sj)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach seporate pagata krgtlty � d�Pd�1 PROJECT --
•- •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING SIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this Permit onlul
h o I e�itR '57- fLtA, lc Dell, S-ie l
PROJECT NAME (Name of Business or Owner Last Name) y e i n n NAM
PEOPLE •- •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
NAME
5��4 r D� IS �` PRIMA Y PHONE
MAILING ADDRESS CITY, ATE, ZIP
Ve w V-4 �t rk mk.t --
COMPANY NAME 72121 5._ `
APPLICANT NAME
to i�,�, c�
OF CE PHONE
(W 'I bl - _0/&6
MAILING ADDRESS
1O�
CITY, STATE, ZIP
rD>� *jP 1 k f f0o 2-
CEL PHONE
('i -?S) -. $
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE --
'FAX NUMBER
— — — — B
L
CONTRACTORS REGISTRATION NUMBER (copy of card required with each application(
EXPIRATION DATE
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP —
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe)
S.
PV
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECFIAA7CAL
Value of Mechanical Work $
_ AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG. SYSTEMS
_ BBQS FANS HOODS(cemmerciaq WOODSTOVES
_ BOILERS FIREPLACE INSERTS RANGES MISC (Describe)
COMPRESSORS FURNACES OAS WATER HEATERS
_ DUCTS GAS PIPE OUTLETS
BATHTUBS (or Tub /show rcombo) SHOWERS WATER CLOSETS (T a q MISC (Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS M fto oswoo 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 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 relian city, including its officers and employees, upon the accuracy of the information supplied to the city as a part of
this application. Q
NAME /TITLE Tn,r,�. _Z) F ^� T
(Signs
RELATIONSHIP TO PROJECT
❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other
Bulletin #100 — January � 2005
Page 2 of 4
MandoutsTennit Application