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Federal Ways --L — — — —
COMM[1M7'YDEVELOPbfE Y , rEo��-wA� PERMIT SF MF CO ME EL PL DE EN
333258TMAYENUESOIffF!(�0&yNG oE�APPLICATION - -
FEDERALWAY, WA 98063-
253S35-2607• PAX 253-835-2609.____.._
www.dtuoffederalwau.com
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PROPERTY•. •
SITE ADDRESS 3 L rZ 9 = , e p- AIA �/ i i', 1✓4jZ , .r- SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # 2-. / C 6 I— - �7 O ,;) a LOT SIZE (sl
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
■ PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING V FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION 01 rw de detailed description of work Included on this permit Ord
'5r -C, alarm
PROJECT NAME (Name of Business or Owner Last Name) eas+ (\4(m(QUS Q(l C.Q. 'Pa i'K Z-7-6- AX, 6
PEOPLE•• •
PROPERTY
OWNER
CONTACT
EXISTING USE
NAIL PRIMARY PHONE
MAILING ADDRESS CITY, STATE. ZIP
z (,/ ve e, X e -e, e- - I -,kl.
COMPANY NAME
4o-�C6 Comm .
Cvr
APPLICANT NAME
5k, ie i aG1C
OFFICE PHONE
G63) q zjo-
CELL PHONE
)2,34
/ 9q7
MAaJNG ADDRESS
00`7 ua. w #�
c".'ZIP
q� "
PA
3v
/J--&
CnY OF FEDERAL WAY BUSINEraS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
z 0- 0 s'- -Z G-�-
z--1- 2- B
L /L/J/ N ti
(0,53) Qz&
-1994
CONTRACTOR'S RIX'dS MMON NUMBER (copy of card requited vkh each appHgtioa
EXPIRAMON DATE
A
1,31
107
PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $_ p` cV"
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGBLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHIINE 11 PRIVATE (SEPTIC)
E
9 16.i
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
PROPOSED
TOTAL
SQ. FT.
SQ. FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT ❑
sasrna
PROPOSED
TMAL
1[4lIIX �W M
Ak rlmleQe�w Nk
TATALN
NUMBER OF FLOORS
Xo
'•NEW HOMES ONLY"* NUMBER OF BEDROOMS
ESTIMATED SELLING PRICE $
of each type of f bdwe to be installed or relocated as part of this project Do not include exlstingJ&tures to
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG. SYSTEMS
BBQS FANS HOODS (comme,cia" WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC (Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
BATHTUBS (-T b/Stawercombo) SHOWERS WATER CLOSETS nb&t) MISC (Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
TAVS (gas,, VACUUM BREAKERS ELECTRIC WATER HEATERS
i certVy under penalty q%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 claGN, 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.
NAME/TITLE Jrn"� fDATE
(S1gMa re� /� 1IUe)
RELATIONSHIP TO PROJECT ❑ Ownef ❑ Agent W Contractor ❑ Architect ❑ Other
Bulletin #100 — January 1, 2006 Page 2 of 4 k\Handouts\Pennit Application