06-102662arms
Federal Way
COMMUNITY DEVELOPMENP SERVICBs
33325 81w AVENUE SOUIN • PO BOX 9718
FEDERAL WAY, WA 98063-9718
253435.2607• FAX 253.835.2609
unuro rityo ederalmcy com
Thefollowina is
I -Sl 3 RECEIVEd
PERMITMAY 3 0 zoos
APPLICAI,I NDERALVI
BUILDING DEPT.
- an
&- 2_& �72-
MF CO ME EL PL DE EN FP
will not be accepted. Please
or
SITE ADDRESS CJ' -I
; (�� �^ Ay e
OFFICE PHONE
SUITE/UNIT #
ASSESSOR'S TAX/PARCEL #
2- 5 Z I
- =1 Q +
LOT SIZE (s])
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
iAttmh &V—fePage/-MVfhg Iegaide&.0dwQ
■ PROJECT INFORAIATION
TYPE OF PERMIT BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this nernit ordul
D +=T rf � n F sr. - � x -r 12 ' " tic
PROJECT NAME (Name of Business or Owner Last Name)
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
PEOPLE INFORMATION
NAME PRIMARY PHONE
�J-ZCzSL. t v ti
MAILING ADDRESS CITY, STATE, ZIP
35-7)7 t In L^J — (.-
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
Cx-i
CITY, STATE, ZIP –
CELL PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE .-
FAX NUMBER
'L
--B
NTRACTORS REGISTRATION NUMBER (eopy of card required with each application) EXPIRATION DATE
L
COMPANY NAME
5AvAnE At5 0 ��►.�
APPLICANT NAME
OFFICE PHONE
( 1 _
MAILING ADDRESS
CITY, STATE, ZIP –
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe) 1
( _
EXISTING USE _ - r_� t a . SSLA-4 12 e r
" � PROPOSED USE SC'G- �
EXISTING ASSESSED/APPRAISED VALUE >���, QnC )` "-' VALUE OF PROPOSED WORK $ I l . Oc `Y') ' °"
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ N.0
WATER SERVICE PROVIDER .X LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ALAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
SQ. FT.
BASEMENT
FANS
HOODS (commerdaq
WOODSTOVES
FIRST
FIREPLACE INSERTS
RANGES
MISC (Describe)
SECOND
FURNACES
GAS WATER HEATERS
THIRD
GAS PIPE OUTLETS
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
SHOWERS
WATER CLOSETS ll'nueq
MISC (Describe)
DECK(COVERED?)
SINKS
DRINKING FOUNTAINS
GARAGE CARPORT ❑ CA91j c
SUMPS
01� S�
—IQV
NUMBER OF FLOORS Magma Paorosco TOTAL :........__„....... r ..
"NEWHOMES ONLY” NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
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
EVAPORATIVE COOLERS
GAS LOGS
REFRIG. SYSTEMS
BBQS
FANS
HOODS (commerdaq
WOODSTOVES
BOILERS
FIREPLACE INSERTS
RANGES
MISC (Describe)
' COMPRESSORS
FURNACES
GAS WATER HEATERS
DUCTS
GAS PIPE OUTLETS
PLUMBING
BATHTUBS (arTLb/she rcambq
SHOWERS
WATER CLOSETS ll'nueq
MISC (Describe)
DISHWASHERS
SINKS
DRINKING FOUNTAINS
GAS PIPE OUTLETS
SUMPS
RAINWATER SYST
WASHING MACHINES
URINALS
HOSE BIBBS
LAVS paahro mss
VACUUM BREAKERS
ELECTRIC WATER HEATERS
I cert{jy under penalty of perjury that the tgormation 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 reliance of the cigr1hel
pding its officers and employees, upon the accuracy of the information supplied to the city as a part of
this application. r101
NAME/TITLE
RELATIONSHIP TO
Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other
S- ILA -06 1
Bulletin #100 — January 7, 2005 Page 2 of 4 k\Handouts\Perinit Application
LEGral. Deltic, 25203 5'i S tIof=-r OF V-1 FZ' OF W \-ISFT Of= E G6O FT Off- Cs�-2