05-102814�OTT OF ECE
Federal Way 1U N PERMIT
coMMI7N7TYDEVELOPMENTSERVICEs 1 5 2005 SF F CO ME EL PL DE EN FP
33325 B^I AVENUE , ATN • BOX 9718 ' P L I C A T I O N
FEDERAL WAY, WA 9806363 -9778
253-835-2607• FAX 253-835-2609 ' OF FE D E ` -
WWw.dfyoffedera7wa mm BUILDING DEPT
The f011owing is requimd Information -art incornp fete application will not be accepted. Please Print legibly in in or tune.
SITE ADDRESS lc%iv / y % ,% -z� 1SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # J_ Q _ (' O 7 LOT SIZE (sj)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach aeparale pope for lengthy legal d—ph—) --
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlvl
PROJECT NAME (Name of Business or Owner Last Name) ry\. C.:1 -t- p lt_
• •- •
PROPERTY NAME
PRIMARY PHONE
OWNER C t` \� L i,- 5 l.� ' 2 �.
MAILING ADDRESS CIW, STATE, ZIP
CONTRACTOR
APPLICANT
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESSITY,
STf TE, ZjI
LGCLre�Cny t
CELL PHONE
(�tj3)
OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIATION DATE
FAX NUMBER
— --- — — B
L
CONTRACTOR'S REGISTRATION NUMBER (copy of card required with each appacatioul
EXPIRATION DATE
UUMPANY NAME APPLICANT NAME OFFICE PHONE
MAILING ADDRESS CITY, STATE, ZIP CELLPHONE
h T1 3 ,� �- �✓ �,r}- y�� try 3)
RF.IATI(1NSRIa Tn oon hcrvn
❑ Architect ❑ Tenant ❑ Agent w6ther (Describe)_ Cg
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
SQ. FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
E)aSrIR6
PROPOSED
ro7N
Toru .
ty'TRoeosW 3r
NO
.{
Ar 6i E
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work
_ AIR HANDLING UNITS
_ BBQS
_ BOILERS
COMPRESSORS
DUCTS
BATHTUBS (or Tub/Shouer combo)
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 (commerciat)
RANGES
GAS WATER HEATERS
WATER CLOSETS goiteq _
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I certify under penalty of perjury that the ir4formation 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.
NAME/TITLE
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑
Bulletin #100 — January 7, 2005 Page 2 of 4 k\Handouts\Permit Application