06-101951 • II
RECEIVED
un or
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FederalWay j___SiCOMMUNI7YDEVELOt1BNrSLRVICg4 P R 1 9 2006 PERMIT SF MF CO ME EL PL DE EN
33325 3TM AVENUE BOU771•PO BOX 9718
►snaRAL WAY,WA 98os3 q9Y OF FEDERAL P LI C AT I ON / /
43 dJS26p7.1►AX?53 43
unvw.divoffederatwomem BUILDING DEPT.
The ollowin, is re, fired information-an inco 'late a••licatlon will not be acre•ted. Please •rent le'ibl n in or
■ PROPERTY INFORMATION
SITE ADDRESS 2,/7 /ac,, I r �� �1"L �S �1,,� SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - _ _.— — LOT SIZE(sf
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) AP )1.)/147g D' Guru 1J--
(Attad&separatr/roa/c.lengthy Jogai draiPHanJ V
■ PROJECT INFORMATION
• TYPE OF PERMIT 0 BUILDING ❑ PLUMBING 0 MECHANICAL
'
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
y l)'t xyriV ((Vg C7
n CI /� j 1
PROJECT NAME(Name of Business or Owner Last Name) I V t,��"I r/J�( Rc� 0f�,0 H v 1 b Aii
• PEOPLE INFORMATION v
PROPERTY NAME
PRIMARY PHONE
OWNER
( ) -
MAILING ADDRESS CITY,STATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE HONE
;id(0— 'Ye 7 \� jos )/ (�0 )4 -C �NADDRESS lr crr� ATE, CELL NE -
JOF FEDERAL:))( BUSINESS LICENSE NUMBER T!i i� 4,EXPIRATION(i' 13-t,
(3 /V( g 7i 3
- -
-B L ' / / (�4./� . 0/CD
CONTRACTORS REGISTRATI N MBER(copy of card required with nick application) MOLVDON DATE
0e6
APPLICANT COMPANY NAME APPLICANT NAME
OFFICE PHONE
(
)
MAILING ADDRESS �. CITY,STATE,ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant ❑Agent 0 Other(Describe) ( ) -
CONTACT NAME (11144 LI)Cli d ii PRIMARY PHONE EMAIL ADDRESE
l'iljtiRC-0>)Col,itd)14----
LENDER NAME
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
r-- ■ DETAILED BUILDING INFORMATION
EXISTING USE q PD Ce
r PROPOSED USE WP .a 0 rat
EXISTING ASSESSED/APPRAISED-VALUE $ VALUE OF PROPOSED WORK $ /c-
LizwESPRINKLERED BUILDING? []YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED%REQUIRED? ikES 0 NO
WATER SERVICE PROVIDER LAKEHAVEN ❑ HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
R SERVICE PROVIDER LAICEHAVEN 0 HIGHLINE O PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
•
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
=ATM PROTON= TOTAL
NUMBER OF FLOORS
"NEW HOMES
ONLY NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commercial)) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS • FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING '
BATHTUBS(.r7ub/Shower Combo) SHOWERS WATER CLOSETS pito MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS Matheson y,dq VACUUM BREAKERS ELECTRIC WATER HEATERS
•
DISCLAIMER/SIGNATURE BLOCK
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/TITL C� DATE
/• /i/V
gide)
RELATIONS TO PROJECT 0 • '- o Agent ontractor 0 Architect 0 Other •
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