06-106390RECEIVE
un of
Federal Way n (� {j �y PERMIT
COMMUNRYDEVELOPmENTSERVICGSEC 2 O 2006
333258- AVENUE SOUTH • PO BOX 9718
,FEDERAL WAY, WA 98063 -9718 p L I C AT I O N
253- 835- 2607• FAX 253 -8 ,Q$y OF FEDERAL
wwwdtvofl'ederaIway . om BUILDING DEPT.
The following is
incomplete application will not be
ia-icogq
I D- 6 !-� 20-
SF MF CO ME EL PL DE EN (FP
D
ted. Please print legibly (in ink) or tune.
SITE ADDRESS SUITE /UNIT #
ASSESSOR'S TAX /PARCEL # $ ✓�- I LOT SIZE (sfi
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) t
/Attadi separate pope jor lengthy legal deseaipttonJ
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECFIANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this Permit onlul
PROJECT NAME (Name of Business or Owner Last Name)
PEOPLE •- •
PROPERTY
�WNER
l
CONTRACTOR
APPLICANT
NAME
—� PRIMARY PHONE
MAILING A ESS r CITY, STATE, MP
COMPANY NAME
AP [CANT NAME
VQ
APPLICANT NAME
OFFICE PRO E
CITY, STATE, Z! —
,
E.
Y
ONE _
MAILINU
ADDRESS
O Architect O Tenant ❑ Agent 0 Other(Describe)
CITY, A ;ZIP
CELL
OF 'FEDERAL WAY BUSINE
BER - EXPIRATIONDATE —7—A
L -B L
NUMBER
CONTRACTORS REGISTRATION NUMBER (copy of card required with each appHeatioa)
EXPIRATION DATE
COMPANY NAME
AP [CANT NAME
VQ
(OFFICE Qpu� a��
MAIL-INU AD ESS
CITY, STATE, Z! —
CELL PHONE
E.
Y
-
REIZO
LA ONSHIP TO ECT
FAX NUMBS
O Architect O Tenant ❑ Agent 0 Other(Describe)
C
AREA DESCRIPTION
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED ?)
UAKAUN U CARPORT U
NUMBER OF FLOORSTpfO rxo-ro —sco
• *NEWHOMES ONLY "' NUMBER OF BEDROOMS
EXISTING
SO. FT.
000
s
SELLING PRICE
PROPOSED
SQ. FT.
TOTAL
S . FT.
8670
number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to
Afecu HICAL
Value of Mechanical Work $
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS LOGS
REFRIG. SYSTEMS
BBQS
FANS
HOODS (ce�uaaq
WOODSTOVES
BOILERS
;:;, FIREPLACE INSERTS
RANGES
M[SC (Describe)
COMPRESSORS
FURNACES
OAS WATER HEATERS
DUCTS
GAS PIPE OUTLETS
PLUMBING
BATHTUBS (or74b /sho rcombq
SHOWERS
WATER CLOSETS (react)
MISQ (Describe)
DISHWASHERS
SINKS
DRINKING FOUNTAINS
GAS PIPE OUTLETS
SUMPS
RAINWATER SYST
WASHING MACHINES
URINALS
HOSE BIBBS
LAVS (e,enoomsinkl
VACUUM BREAKERS
ELECTRIC WATER HEATERS
r cert{fy under penalty of periury that the information furnished by me is true and correct to the best of my knowledge, and further, that 1
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 clainq, 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. J�
c " W if%/K�O
NAME /TITLE /JP�$i'ti;.i8v�. DATE
(Signature) )
RELATIONSiIP TO PROJECT ❑Owner ❑Agent ❑Contractor ❑Architect �v they 5.4 efon rih,!,
F
Bulletin # 100 - January 7, 2005 Page 2 of 4 k\Handouts\Pemtit Application