06-101952 i • 11111(1
cto4P RECEIVED 4 - 40....i_tiz.,FederalVPERMIT
SF MF CO ME EL PL DE ENel
;31 Ent A ErUE 30:770 RTA RR 1 9 2006, P
333?F R WAY, A7i/.fo9 f� 1`1 pLI CATI O N
FEDERAL WAY,WA 98063-971S TD
253-435 2607 FAX 253435-2609 / /
,utata•dr aderahuategY OF FEDERAL WAY
BUILDING DEPT.
The ollowin• is red information-an Inco •tete a,•lication will not be acre•ted. Please •rint to•ably n in or
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A PROPERTY INFORMATION
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SITE ADDRESS (2I"/ a C)1 1)C u/' .t...-...___/0 SUITE/UNIT#
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ASSESSOR'S TAX/PARCEL# - _ _ _ LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
• (Attach a.parta*Pagafar whir lalicd deo:Odor)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING J FIRE PREVENTION SYSTEM
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PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) ,
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PROJECT NAME(Name of Business or Owner Last Name) 1. X? :5)ye 5C*
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER ( ) -
MAILING ADDRESS CITY,STATE,ZIP
CONTRACTOR COMPANY
NAM-Ei APPLICANT NAME l �/� OFFICE ONE
L�iAtitlr3e>�D iS ' 4 7C i�,P I I UjffC11 1�0 'i �-v j a
V
CELL NE ��
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CITY OF FEDERAL WAXNESS LICENSE/ER Tuftwoi,EXPIRATI,DA E ct-10FAXNUMBER
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GL )1,-.)-0_ L ='�'' . / / ( ) -
B L
CONTRACTOR'S REGISTRATION NUMBER co and ed with each application) EXPIRATION DATE
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APPLICANT COMPANY NAME 1 APPLICANT NAME OFFICE PHONE
MAILING ADDRESS cQ v CITY,STATE,ZIP CELL PHONE
r ( )
RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect 0 Tenant 0 Agent a Other(Describe) ( ) -
CONTACT NAM PRIMARY PHONE E-MAIL ADDRESS
ao, r , t1. A ( .) -
LENDER NAME
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
■ DETAILED BUILDING INFORMATION
EXISTING USE g' PROPOSED USE
EXISTING ASSESSED/APPRAISED VAL �$
L/c/ VALUE OF PROPOSED WORK $ 494F/1 U
SPRINKLERED BUILDING? ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ' YES a NO
WATER SERVICE PROVIDER LAKEHAVEN ❑ HIGHLINE
a TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 VEN 0 HIGHLINE
0 PRIVATE(SEPTIC)
110 •
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PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT. a
BASEMENT
FIRST
SECOND •
THIRD
FOURTH
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ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
warn= PROPOS= TOTAL I
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 lc.mm..a.q WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING •
BATHTUBS far Tub/Shower Combo) SHOWERS WATER CLOSETS Ir=aq MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Batl¢oom swul VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I cert(f y 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 flied against the City of Federal Way,but only where such claim
arises out of the reliance of the city,including its officers and e , - ogees,upon the accuracy of the information supplied to the city as a part of
this appticatton •
NAME/TITLE/ 117, / C%LO Y a ` DATE
RELATIONS so' • PR. y C) Owner 0 . :en Contractor O Architect O Other •
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