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......h. RECEIVA. - 1 /3 1 1 q 5
Federal Way - PERMIT SF MIT CO ME EL Pt, DE El' Ofr
3:71:7)2145144.7gk'VF".5'043.Mth:F1 05f)iC7E7SIE
ILLIER.,,L IYAY,WA 9846:9118 APPLICATIO
?53 833 2607.-FM 23,3-835-2664
822.fe_4_811.4174,1c.149,4gjau
CITY OF FEDTV:t17VAV---/ 4
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SITE.ADDRESS 30 SS •S ‘i ..._,„ I_ rcv-&: . SOITE'/UNIT N
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ASSESSOR'S TAX/PARCAT.* 0 3 I _ - LOT SEZE(.5.0
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itiajtri4k1FORMATIO l'-',', .l., • ., ., , , ' ',
TYPE Or PERmrr U BUILDINci U PLUMBING AECHANICAL
0 DEMOLITION 0 ELECTRICAL U ENGINEERING XFJP..E FRErENTION SYSTEM
PROJECT
DESCRIPTION rvide detailed de.1.6npfiort of tvoTAI ittdUdeti on this irrntEt csnlyi I ,
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PROJECT NAME(Name of 4.3wArtess,or Oluirter last Plairiiii ___ ---,MA/ _ IP' , e _ . 01/"S
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N#bamATioN
PROPER ry
OWNER -k z
(...,, ,---tts •<-l 0 -- 441 Lills• •---(ja5 /Lei.
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-MAILING ADORESS rj CITY,„i rrakz,4:le „‘ I
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cONTRACTOrt COMPAI,6 NAME A','LICAlie--NAI,n, ‘ OFFICE MONK -I
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MAILING ADETIF"?..S.S V- --F- LY. .I. 1- --- ---4
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CITY 617 Fe.!ARAI WAY t4".fNI,St,1. SE NUMBER-- --1 . 4‘;crirtAftat4 rAIE-----'-11g NtIMOER-
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APPLICANT -71.7.1Iiirr7);17+ro v —--— APPLicA..47 NA'AFT------------ JFF1EE PHONE
M ILNIA-e 1 / -
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--,,,, ,,,,,514,5,.,--- FAX Numartk
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0 Arctutect 0 Tenant u Agcril 0 Other fr.o..r.cabe) _ , .., ( -
CONTACT 7,iiii r-)' rr. 1- —- ----7.KrZmA KY PtiORr---------11Frii.7,c7r.gz frti..f _o.ei_4)
LENDER 777,Ti;iii,,:.:77 7; f:$Tf,-w,it,'''`" NAME p
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N D . 1MAILRE.i1 ---- :',3TY,,5TATE,ZIF
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,,,,:,,. ,, '. . ;,‘' • ,,-, , ., ,, , „ ...1 'DETAILED EitIILDINP INFORNAIWN
ExisTmo ITS8PROPOSED USE
— ..
EXISTING ASSESSED/APPRAISED VALUE $._ VALUE OF PROPOSED WORK $
SFRINKLERED BUILDING? t.E.,S a NO FIRE SUPPRESSION SYSTEM PR.OPOSED/RE.QtnRE,'D? X YE o NO
WATER SERVICE PROVIDERLAKERAvEN 0 HIG :LXN 'i H 't
0 TACOMAPRIVATE(WELL)
—
SEWER SERVICE PROVIDER. *LAKELAVEN 0 RIORLINE ___C_PRIVATE(SEPTIC) _....,
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i i7..A D ekirY T01--_____._._.-__... ---- ,Ai3'3',ING — PStl7P(7___ __I_____-_._'r07'A.E.
S F r 5q. FT. f .._._______2_ FT,_______
T BASEMENT
i_______________
I FIRST 1
ThIRD
ABDITICi__AL FLOORS___tnESCRJ>�Ej-_.. .._.�._ ----.- -__� — -_—_1
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� DECK ;CG�EFt£I'1.) -_ ___..._.—�._, .--__-�. ._.__._- � __----
1 GARAGE 0 CARPORT 0 —_— ___
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LUMLROF1OORS _.- -.:! t_. _. �+ --------- �. I�
sr:
"{NEW HOMES ONLY" NUMBER OF BEDROOMS ES;'(MA'C>;'I7 SEL1.iNCi I;RIc ' S__- -
Jrulrctaie number of each type of future to be ir.Studect or relorottd as part of iii:•project, Do not in<:•it»de extsling fix-lures to 7 i;rt,
!Vufi.y nj Mocha ntorI Work $ 11 ok'
• �,� AIR:HANDLING UNITS _ CVA1'ORATIVK 0001-t:^S GAS LOGS __, _� REFRIO, :}YSTt:M+S
_ BBQS _
. FANS _ _ .__ )40013~tc, R:w; WOOUSY'OvEs
. riOtLENS WIINVLACE IN5)';KI3 ,. RANGES MPSC io
tntcr;be
_ COMPRESSORS � FURNACES GAB WATER HEATERS
DUCTS .445-y OA MPS C?tlT1.F7 3 '
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IF
I P/.UDD?ING
IE1.M1FrUCC IaTur.•3ee ac6.661 _ SHO'JiERS _T Wn7E:R CLOSETS cr.a.. __ - MISC (b,scrinc}
1 D1SIIWASItERS SINKS URU'KINO FOUNTAINS
GAS PIPE OUTLETS _ SUMPS NAINWA'tER 3YS'r
—� WASH1N( MAC MIN..S — . URJNALS — HOSE MEWS
�, -�_ IAVS tB.dvn.m:blla, VACUUM BREAKERS _.- __-.__ Et•L'C71RIC WATER H .ATE'tL: ---- __
r -J certUyy:trader penaity of perjury that tit.information Tarnished$yam Mme Is true and co,:ect to the best of my knowledge.and further, eh!at3'
m
aauthor ted by the ,inner of the above premises io per/tarn the work fur which the parm(t application is intact. 1 further gyro. to hard
harmledd the clt,y of Iedera! Way as to any claim(including costs, expenses, and attorneys'fees incurred in the inanest-lgution cend d erase of )
I jucY,ela7imJ,which myy be mads by any person,tnrtudtng the undertigressi, and filed against the City of Federal Way,but only where as h claim
8 oriscs u,ut of the reilanae RI tt+.city, Including Itar offtctrs and emptoyees, upon the accuracy of the tnforintttien su piled to the ceeT,cis part of
} tilts rwpiteuttort.
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NAME/TITLE iTLU .. .,.____Z :',._, 'c C=--. . _ —DATE % .WO-Y; 0,six.uutam) (Title) — I
i RELATIONAHIPZO PROJECT D Owner �
Agent Contractor o Architect 0 ()their
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HSulll:t'n 000-^January 1,2006 __ Page 2 of 4 - - —k`,H:umdpuls\Pcrmit Application