06-1021109
error RECEIVED
Federal way PERMIT
CONAnffffDEVELOPMWSERVJei'SR 2 7 2006
333258THRAL WA , WA 9• PO 971 9718 p p L I C AT I O N
FEDERAL WAY, WA 98063 9718 ,
253 -832- 2607•PAK263 *M*OF FEDERAL
mmm.diuo/%demlmau.rom@UILDING DEPT.
SITE ADDRESS 1405 5 3yP2h 5k FedL
ASSESSOR'S TAX /PARCEL #
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
■ , PROJECT INFORMATION
•
SF MF CO ME EL PL DE EN(F
SUITE /UNIT #
LOT SIZE (sfl
TYPE OF PERMIT ❑ BUILDING . ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING X FIRE PREVENTION SYSTEM
PROJECT. DESCRIPTION (Provide detailed descrip ' n of work included on this permit onlu)
Zi2 GL T 12Q U c A ✓
1 '
PROJECT NAME (Name of Business or Owner Last Name) - - - - ►n0 % TS 11 r� �S �/�' �� AaJS 1
PROPERTY
OWNER
CONTRACTOR
,tw
APPLICANT
CONTACT
LENDER
NAME PRIMARY PHONE
(Sod ) 5%(p.- (h81
MAILING ADDRESS , , ST TE, ZIP
hTech ► 8 0
COMPANY NAME
Ae�tm an �C .
APPLICANT NAME
OFFICE PHONE
&I ) �
MAILING ADDR S
'w /7 7 `
MAILING ADDRESS
� n !1l•
y *30
,STATE, ZIP �
o a �\ M8(M
CELL PHONE
& '? '7
- 3Yq 7
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
1 0- - Q (v -1 Q L q & L - /,2 131 /-?dam
FAX NUMBER
(Bo1 ) g9?
�-
B L
CONTRACTORS REGISTRATION NUMBER (copy o[ eard required with "ch application)
z�P
EXPIRATION DATE
/.
eA mM fze her Srr.
�7vm E C�
(81W q9 - 3 783
MAILING ADDR S
'w /7 7 `
C , STATE, ZIP
CELL PHONE
(2mb8) &97 -347
RELATIONSHIP TO PPOJECT
❑ Architect ❑. Tenant ❑ Agent ❑ Other (Describe)
FAX NUMBER
(801 ) 3 Y 9 -.?q&7
EXISTING USE PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE i$ VALUE OF PROPOSED WORK >� �. QQC%
SPRINKLERED BUILDING? )(YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED %REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAMIAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
• 0
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
3 . FT.
BASEMENT
FIRST
y8 000
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK(COVERED ?)
GARAGE 0 CARPORT O
NUMBER OF FLOORS
saurao
raorosm
ror�e.
*''NEWHOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
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
BBQS
_ BOILERS
_ COMPRESSORS
.DUCTS
PLUMBING
BATHTUBS (or TLb /shower Co-"
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS path, sh*4
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS ic...mw)
RANGES
GAS WATER HEATERS
WATER CLOSETS (r u.4
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I cent{ jy under penalty of perjury that the friformation furnished by me is tree and correct to the best of my knowledge, and further, that I
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 claim, which may be made by dny 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
(Signature) (Title)
RELATIONSHIP TO PROJECT n Owner 0 Agent Contractor 0 Architect O Other
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