10-104963*PERMIT
l Federal baa ZQ�.Q
f,OIl� 3-835-Y DEVELOPMENT SERVICES AAL I C AT I O N
253-8 ;.5-2607• FAX253-8.35-2609 �^ �L
FED K
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MF CO ME PL DE EN P
J U Own,
SITE ADDRESS
s U 3 V/ s l
SUITS/
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL N
TYPE OF PERMIT
CHANICAL
❑ BUILDING ❑ PLUMBING ZE
❑ DEMOLITION ❑ ENGINEERING PREVENTION
NAME OF PROJECT
Name/Homeowner Last Name)
'
S ��
(Tenant
PROJECT DESCRIPTION
Detailed description of work to
IQ Fe 3
G i K—
(3 Ca -
be included on this permit only.
N
PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS t - -
E-MAIL
CITY
STATE
ZIP
NAME
-T
PHONE
C- ' Tl
.
RA
MAILING ADDRESS
6 (v (D . S
E-MAIL
CITY
STATE
Z o
FAX
WA STATE CONTRACTOR'S LICENSE 9 EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE Y
NAM
PHONE
APPLICANT
MAILING ADDRESS -
E-MAIL -
CITY - STATE ZIP -
FAX
PROJECT CONTACT
Nana.
PHONE
(The individual to receive and
MAILING ADDRESS
E-MAIL
respond to all correspondence
concerning this application)
CITY
STATE
ZIP.
FAX
ALTERNATE CONTACT NAME: PHONE
E-MAIL
PROJECT FINANCING
NAME
OWNER -FINANCED
Required value of $5, 000 or more
MAILIINO DRESS, CITY, STATE, ZIP
PHONE
_ (RCW 19.27095) _
I certify under penalty of perjury that I ani the property owner or authorized agent of the property owner. I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I wilt comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal [Day 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,
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
V:=atlon.
Z ^/SIGNATURE:
DATE �
PRINT NAME: (Z,.
Bulletin #100 — April 14, 2010 Page 1 of 3 k:\Handouts\Permit Application
The following is required information -an incomplete application will not be accepted. Please print legibtu fin ink) or tune.
SITE ADDRESS: /er r 7�r _<,' 73 / � 7- SUITE/APT #
ASSESSOR'S TAX/PARCEL #: .3 r 0 3 9- 0 0 0 7& SQUARE FOOTAGE OF LOT: 4/7347
LEGAL DESCRIPTION (e.g,: Acme Estates, Lot 1)
(Attach separate page for lengthy legal description)
PROJECT INFORMATION
TYPE OF PERMIT (This application): 13 BUILDING 0 PLUMBING 13 MECHANICAL 0 DEMOLITION
OELECTRICAL 0 ENGINEERING 9FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this Permit onlyA
joeZj�_
Pu � 7-,4a- /,/ Y
<0 ,!21962 C_7S; -5 1 e) /k_) IAJ Pte/ Aj -r- /
PROJECT NAME (Name of Business/Owner Last Name): Fez kE( 17 16A, 66 t 5*
PEOPLE INFORMATION
PROPERTY
OWNER:
CONTRACTOR:
LENDER:
(1f P—p.o.d Val.. > $5,000)
APPLICANT:
EXISTING USE:
NAME: H tz- IV S rL L2 19 tE PRIMARY PHONE:
MAILING ADDRESS (STREET ADDRESS;): CITY, STATE, ZIP
NAME
(L T Hoc r)
COMPANY -
OFFICE PHONE:
W6)726
COMULVIlY DEVELOPMENT SER VICES
CITY, STATE, ZIP
5i= P+ W,,+ 41 4 10
0
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: EXPIRATION DATE:
ecy
j
, O BOX 9718
33530 FIRST WAY SOUTH - P=FEDERAL
clirf,
Rederal Way
PERMIT
APPLICATION
WAY, WA 98063-9718
253w6WC15F 129
NAME:7DAYTIME
PHONE:
wax6o1m4
CITY, STATE, ZIP
eoffi6i
. . ... ... ... . ...... ......
The following is required information -an incomplete application will not be accepted. Please print legibtu fin ink) or tune.
SITE ADDRESS: /er r 7�r _<,' 73 / � 7- SUITE/APT #
ASSESSOR'S TAX/PARCEL #: .3 r 0 3 9- 0 0 0 7& SQUARE FOOTAGE OF LOT: 4/7347
LEGAL DESCRIPTION (e.g,: Acme Estates, Lot 1)
(Attach separate page for lengthy legal description)
PROJECT INFORMATION
TYPE OF PERMIT (This application): 13 BUILDING 0 PLUMBING 13 MECHANICAL 0 DEMOLITION
OELECTRICAL 0 ENGINEERING 9FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this Permit onlyA
joeZj�_
Pu � 7-,4a- /,/ Y
<0 ,!21962 C_7S; -5 1 e) /k_) IAJ Pte/ Aj -r- /
PROJECT NAME (Name of Business/Owner Last Name): Fez kE( 17 16A, 66 t 5*
PEOPLE INFORMATION
PROPERTY
OWNER:
CONTRACTOR:
LENDER:
(1f P—p.o.d Val.. > $5,000)
APPLICANT:
EXISTING USE:
NAME: H tz- IV S rL L2 19 tE PRIMARY PHONE:
MAILING ADDRESS (STREET ADDRESS;): CITY, STATE, ZIP
NAME
(L T Hoc r)
COMPANY -
OFFICE PHONE:
W6)726
MAILING ADDRESS (STREET ADIRI
,6 10C) ( 2 T -r
CITY, STATE, ZIP
5i= P+ W,,+ 41 4 10
CELL PHONE;
- (
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: EXPIRATION DATE:
ecy
j
PAX NUMBER:
--2?
RELATIONSHIP TO PROJECT:
CONTRACTOR'S REGISTRATION NUMBER:EXPIRATION DATE:
T_
(copy of card required with each application)
NAME:7DAYTIME
PHONE:
MAILING ADDRESS (STREET ADDRESS;):
CITY, STATE, ZIP
NAME:
COMPANY
-
OFFICE PHONE:
6 0 A_r- P -I 7-0 �
-
MAILING ADDRESS (STREET ADDRESS):
CITY, STATE, ZIP
EVENING PHONE:
-
RELATIONSHIP TO PROJECT:
FAX NUMBER:
0 Architect 0 Tenant 0 Other (Describe):
DETAILED BUILDING INFORMATION
PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $ 5,-, 0 0 62
SPRINKLERED BUILDING? 0 YES >!�NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED?: AKYES 11 NO
WATER SERVICE PROVIDER: o LAKEHAVEN 0 HIGHLINB
SEVIER SERVICE PROVIDER: 0 LAKE VEN 0 HIGHLINE
V\
ID
• TACOMA 0 PRIVATE (WELL)
• PRIVATE (SEPTIC)
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