06-101950 i 11111 III
ur�iA RECEIVED
ob - _i_a_ t_g_a-
�'ecteral W
COMWtrrDismo?M NrssR 1 9 2006 PERMIT SF MF CO ME EL PL DE EN
933TSdERALWAVENUE,WASOUTH 9•PO 7 ppLI CATI O N 4
fBDSRAL WAY,WA 9d06J-9714 TD
2P 5-seo7•PAX r'N FEDERAL / • /
""°"''a`"a e�UILDING DEPT.
The ollowtn• is re• ired in ormation-an Inco •late a• ,lication will not be acce•ted. Please •rint le• •1 in in or ty,.
/,y
I. PROPERTY INFORMATION
SITE ADDRESS 2I2/`/ /0(2(24 I f(C' /-10/ \S J)—/0.2-- SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - _ I,OT SIZE(s)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) ()/1i L b D • P-1
Mtgad.&Warta*O for lapt il!Nal descrOgton)
IN PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERINGFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit on6J
/ - J � / �F ,1327 ---414./.
•
PROJECT NAME(Name of Business or Owner Last Name) v/j lI P 130Lk)/) )4 1"l( v
NI PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER ( ) _
MAILING ADDRESS CITY,STATE,ZIP
CONTRACTOR COMPANY11NAME4 APPLICANT NAMB OFFICE HONE
ISL e�� 4 � ar's ���aY �� �- �C
AD RE3S 7.,AK 4. p �CELL P N
j� 1 n ►� 7
CITY OF FE RAL WAY BU�C�E NUM ER I E IRATION DAT' i FAX FA LER
-B L ' / / ( )iiZ)rC)
CONTRACTORS REG' • TI.N NUMBER leo oto d ngalrad with smeltapplication) EXPION DATE
-H Q--YLLS- '14 •-•?i5f) k:=2 — A)1 171,e)it
APPLICANT COMPANY NAMEAPPLICANT NAME
OFFICE PHONE
MAILING ADDRESS 5----9 �,'� .P CITY,STATE ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
a Architect a Tenant a Agent ❑ Other(Describe)y ( ) -
CONTACT NAMF,_j '_I i_ PRIb<jU�y HONE
v) 4l�j�l]�I IFJj —7 17- E-MAIL ADDRESS
LENDER NAME 2
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
■ DETAILED BUILDING INFORMATION
EXISTING USE $�(,AM,4-- PROPOSED USE i
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ _
SPRINKLERED BUILDING? ❑YES (If NO FIRE SUPPRESSION SYSTEM PROPOSED%REQUIRED? YES a NO
WATER SERVICE PROVIDER LAKEHA(If
a HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER �VEN a HIGHLINE a 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
wsuraa PROPOSED TOTAL
NUMBER OF FLOORS
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECEIANWAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS _ REFRIG.SYSTEMS
BBQS FANS HOODS(C.mmeretd) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING '
BATHTUBS IKT1ib/SlfOw.l Combo)
SHOWERS WATER CLOSETS ai.q MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAYS tsNess VACUUM BREAKERS ELECTRIC WATER HEATERS
•
DISCLAIMIER/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 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 empl. es,upon the accuracy of the information ••lied to the city as a part of
this application. ,/
NAME/TITLE #4 w J14
RELATIONS S 1 �• PR• q Owner 0 Ag •t % Contractor []Architect Other •
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