08-104549 c�edra' CEJvED0._(c_ / d L(
Feral v�a�
PERMIT SF MF CO ME EL PL DE EN
COMMUNITY DEVELOPMENT SERV!
33325 F AVENUE SOUTH•PO BOX 2 5 2006AP PLICATION T�
FEDERAL WAY,WA 98063-9718 i
253-835-2607•FAX 253-835-2609
www.cit-mercy FEDERAL WAY
The ollowin• is re•ui •• ;1_ ation-an tricorn•fete a.•lication will not be acce•ted. Please •rint le•ibl (in ink)or t ••.
• PROPERTY INFORMATION
SITE ADDRESS F- DI i /,, 0�1, Sa (3 SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# ct a L✓ V t - O t 0 LOT SIZE(sj7
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
Rued,separate page for lengthy legal description)
PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
iJ u ava.:1 Aviv. u .a a...: suvFu. u l a`11 lrIN1Is:12it4Cr ' 1.
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PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
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• PEOPLE INFORMATION
vwi. x_ 'i1 r art . Mai� C( I VI l C t -
MAILMIW( 1 s*- w s CITY. (I I teCV, WAI
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
STA:Te fiiaGii.ANIc-4L ?yr) l.corrcl{giAN' (got, )576 - 76d7
MAILING ADDRESS CITY,STATE.ZIP CELL PHONE
400 I At ovt rAY De ti. $ Tlitivi L.-4, VA Imre (Rot. )35 4 - h159
CITY OF FEDERAL WAY BUSINESS LICENSE NU R EXPIRATION DATE FAX NUMBER
1°-- '.-_I. Q c_`t_ lr -B L 12— /,3t laci ( ) -
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
Sr 6TG lvI c. 1 4 1, Cr7 ct / / / 09
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
sr$r6 /l6Csmaic.A` av4) 14w.oS'Ps kM4AI (200575 -75a7
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
600 In100srXYOA'#a 1:0l!
• S i
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing factures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(common/44 WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES ) GAS WATER HEATERS
DUCTS , GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS(Toilet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
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 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. q
NAME/TITLE !��4 �'^"`� f DATE ` �(25--03
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner o Agent I Contractor 0 Architect 0 Other
FOR OFFICE USE ONLY
NEW L ADDITION ❑ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? n YES c NO BASIC PLAN? o YES ❑NO
ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? ❑YES o NO
PLATTED LOT? n YES n NO DEMO PERMIT REQUIRED? n YES n NO
Bulletin#100—January 1,2006 Page 2 of 4 k\Handouts\Permit Application