06-104335RECOIVED
CITY OF A AUG 2 g 2006
Federal Way PERMIT
COMMUNITY DEVELOPMENT SE O F F E D E R
333258T"AVENUE 's' or" LI CATI ON
FEDERAL WAY, WA 980&3.9718 U I L D I N G D
253.835-2607• FAX 253-835-2609
www.cLoKederalwau. min
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SF MF CO ME EL PL DE ENCFPD
ASSESSOR'S TAX/PARCEL # 2 T G�/��/I'N( `- Q AA0 1 O LOT SIZE (s� 1015779- /p Sr
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) Ay113 &APl4�2K- t ��p_ T CG f 04. ' T)
(Attach separate pagef- lengthy legal d—oto V
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING YFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu/
POVI/lbf- I- kX- FI(ef '56670M ?O PNI-gC-f 41,teGL-
j1xW'W141 = 31.3, ?*0. —
PROJECT NAME (Name of Business or Owner Last Name) 601 MMPI%I NAM-- Aousa lb A
PEOPLE•• •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
NAME PRIMARY PHONE
Li (Zoe, ) p 3'
MAILING ADDRESS CITY, STATE, ZIP
141ke '"r.A&M t&/+- 98/0 6
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
SMITH FIRE SYSTEMS, INC.
SHIRLEY GLASSMAN
( 253)926-1880
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
1106 - 54TH AVENUE EAST
TACOMA, WA 98424
( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
1-9-87-0-00 05 1 -BL
12/31 /06
( ) -
CONTRACTOR'S REGISTRATION NUMBER (copy of card required with each application)
EXPIRATION DATE
S M I T H F S 1 3 6 0
T
11/ 02 /06
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
SMITH FIRE SYSTEMS, INC.
SHIRLEY GLASSMAN
(253 )926 -1880
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
1106 - 54TH AVE E
TACOMA, WA 98424
( ) -
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant KAgent K Other (Describe)EMPLOYEE 1
(253 ) 926 -2350
NAME PRIMARY PHONE E-MAIL ADDRESS
KEVIN BELL (253) 926 - 1880
Per$Clsd'1;Ia�" y ,(t'�'
reset( it�eat pi3Cu7 eced�
NAME
NSA
MAILING ADDRESS
CPIY. STATE, ZIP
PHONE
EXISTING ASSESSED/APPRAISED VALUE $_
SPRINKLERED BUILDING? �7 YES ❑ NO
WATER SERVICE PROVIDER �i LAKEHAVEN
SEWER SERVICE PROVIDER ❑ LAKEHAVEN
PROPOSED USE
VALUE OF PROPOSED WORK $
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? YES O NO
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
O HIGHLINE ❑ PRIVATE (SEPTIC)
E
PROJECT FLOOR AREAS
9
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
SO. FT.
BASEMENT
FIRST
l
I
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
r
w
DECK (COVERED?)
GARAGE 0 CARPORT
NUMBER OF FLOORS
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rtnut1?
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**NEW HOMES 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
Value of Mechanical Work
AIR HANDLING UNITS
BB9S
BOILERS
COMPRESSORS
DUCTS
BATHTUBS (or Tub/Shower comb.)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS (bathroom Sinks)
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS Icommemiaq
RANGES
GAS WATER HEATERS
WATER CLOSETS Mikt)
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
to remain.
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
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 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 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 L1AJJATE
( gnature) I MUC)
RELATIONSHIP TO PROJECT ❑ Owner Agent ❑ Contractor ❑ Architect Other_(�iyNG�
�%iiT�fll a A2.IitA1`ItlN o P1k p 1`EhIANT i1VlPY�U1tENT
fix isN ? n ❑ w?", PLAN? ❑ YEs ti NO
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Bulletin #100 -January 1, 2006 Page 2 of 4 ktHandoutslPermit Application