05-105732Cffr0F
Federal way
COMMIAMY DEVELOPMENT SERVICE$
33325 81HAVENVE SOUTH • PO BOX 9718
FEDERAL WAY, WA 98063 -9718
253-835-2607-M253-835-2609
www.dtuoffederaftyau.com
is
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PERM LT O 20 5 SF MF CO ME EL PL DE E FP
APPLI CATI DA�.
CITY
BUILDING DEPT.
SITE ADDRESS
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- ZZ90
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ASSESSOR'S TAX /PARCEL # U I - 9 0
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CRY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
1 19 - 9 1- 1 0 1 9 8 S - 122- / 31 / ZC�S
LOT SIZE (s, f j
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
!Armen separate pMef- LrW& g legal de -roUDN
or
PROJECT •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING 4IRE PREVENTION SYSTEM
PROJECT DESCRD?TION (Provide detailed des , tton of work inchided on
Ms kwAl F; rc. So n, A --r CguAcm ,„ Fel
PROJECT NAME (Name of Business or Owner Last Name)
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
E PEOPLE INFORMATION
PRIMARY
C PANY NAME p
G,`� r� ' F1 re. 1(a �iol1
APPLICANT NAME
OFFICE PHONE
(m) 9Z6 .
- ZZ90
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c�aco� WA 9547,4
/EId PHONE
IFAX
-
CRY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
1 19 - 9 1- 1 0 1 9 8 S - 122- / 31 / ZC�S
NUMBER
(63 ) `IZZ
- 61SD
B L
CRY, STATE, ZIP
CELL PHONE
CONTRACTOR'S REGISTRATION NUMBER (copy of card required with each application)
P�Ti. I FY 099 CF
EXPIRATION DATE
lv /S /ZD6
COMPAq NAME
APPLICANT NAME
OFFICE PHONE
MAILUM ADDRESS
CRY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant
❑ Agent ❑ Other (Describe)
PROPOSED USE NCW &J.
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK
SPRINKLERED BUILDING? d! YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? DYES
WATER SERVICE PROVIDER ALAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
r
1`1
PROJECT e•• AREAS
AREA DESCRIPTION FMsTING PROPOSED TOTAL
SQ. FT. SQ. FT. I SO. FT.
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBP,; ,
DECK (COVERED ?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS RXISTM roses
"NEW HOMES ONLY" NUMBER OF BEDROOMS EI
Indicate number of each type of fiuh.cre to be Installed or re ed
MECHANICAL.
Value of Mechanical Work $
AIR HANDLING UNITS XERATIVE OOLERS
BBQS BOILERS RT 'S
COMPRESSORS DUCTS TS
BATHTUBS (oriUb /sh rCOmbo)
SHOWERS
DISHWASHERS
SINKS
GAS PIPE O
SUMPS
WASHING CHINES
URINALS
LAVS (Bathroom sinks)
VACUUM BREAKERS
as part of this project. Do not
GAS LOGS
HOODS (commeretai)
HEATERS
WATER CLOS nbllet)
DRINKING F 3UNT.PJV S
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEM
remain.
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I cert(fy under penalty of perjury that the Wormation 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 qj Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in the investigation and defense of
such clainO, 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 o_ ficers and employees, upon the accuracy of the irtformation supplied to the city as a part of
this application.
NAME /TITLE �O� + 1 iO�C MA-K Xlee' DATE 'VU*vbe" 3 Zws
(Signature) (Title)
RELATIONSIUP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other
Bulletin #100 - January 7, 2005 Page 2 of 4 k\HandoutsTermit Application