06-102692QTY OF RECEIVED
F'ederalway PERMIT
ODaIMUMiYDBVBGOFM6Nf 5� 3 1 ""APPLICATION
006
3332FEDEMNUE SOA771• FO A P P LI C AT I O N
FEDERAL WAY, WA 98063-9718
253 835 2607• FAX 253 9
unn,,.at,�ire'=MF FEDERAL WAY
BUILDING DEPT
SF MF CO 5 E EL P E EN FP
The following is required information -an incomplete application will not be accepted. Please print lealiblu lin inkl or tune.
SITE ADDRESS t' S 3 -3 �'j `' 5-�- SUITE/UNIT #
ASSESSOR'S TAX/PARCEL #_l �� =b LOT SIZE
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) 0 f c, / %M/1
(A -ch ~Jbr WwftIMW dssafp wq
PROJECT• •
TYPE OF PERMIT 69PUILDING . ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit on(vl
PROJECT NAME (Name of Business or Owner Last Name)
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
NAME PRIMARY PHONE
S+x71 ALL ( ei)'7?+5 roSsZ
MAILING ADDRESS CITY, STATE, ZIP
&k-, N • WivmW5,� 2, V2 d
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
APPLICANT NAME
OFFICE PHONE
P>Fc-l/
MAILING ADDRESS
CITY, STATE, ZIP
(253)7Zr__ -35 11
MAILING ADDRESS
1�61 1/41
lj cj
RELATIONSHIP TO PROJECT
CITY, STATE, ZIP
ZC u� 3 ¢
CELL PHONE
( ) -
,
v (,�,//-
CITY OF FEDERAL WA BUSINESS LICENSE NUMBEI EXPIRATION DATE
FAX NUMBER
( ) -
_-
CONTRACTOR'S REGISTRATION NUMBER (co
of Card required with each application)
EXPIRATION DATE
CZ4
C
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
C_
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
yArchitect ❑ Tenant o Agent ❑ Other (Describe)
�L) c(fil�*(_ JAavL-Am,> I ( T
, STATE, ZIP
PHONE
EXISTING USE( e�.,,,4'JUT PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE? �l VALUE OF PROPOSED WORK $" ` �/
SPRINKLERED BUILDING? d YES �24 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 11 PRIVATE (SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING PROPOSED TOTAL
SQ. FT. S . FT. S . FT.
BASEMENT
HOODS (comma
FIRST
RANGES
SECOND
GAS WATER HEATERS
THIRD
ELECTRIC WATER HEATERS
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS EXIST" raMOSM �
**NEWHOMES ONLY** NUMBER OF BEDROOMS MATED LUNG PRICE $
Indicate number of
Value of Mechanical Work $
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
.DUCTS
PLUMBING
BATHTUBS (or Tub/sho rCombo
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHIN
LAVS B*thmom st ka
T
or reiocafdd as part
not
EVAPO TIVE COOLERS
GASLOGS
F
HOODS (comma
PLACE INSERTS
RANGES
FURNACES
GAS WATER HEATERS
GAS PIPE OUTLETS
ELECTRIC WATER HEATERS
SHOWERS
WATER CLOSETS (ro&q _
SINKS
DRINKING FOUNTAINS
SUMPS
RAINWATER SYST
URINALS
HOSE BIBBS
VACUUM BREAKERS
ELECTRIC WATER HEATERS
to remain.
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I cert(jy 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 claiveh 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 relian o city, includin its gjji d employses, upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE DATE d , 3i , U
(Signature) (Title)
RELATIONSHIP TO PROJECT a Owner gent 0 Contractor ❑ Architect o Other