05-104938 ' ��c��� �
�.��� � - �
Federal Way SEP 2 6 �pq� P -�+ ��/j r'I'' � � -� � �-�-�
OOXA(UMTYDBVBLOPAfBKfSBRVlCSS SF MF CO ME EL PL DE E FP
3J3�5dTMAVSNUS SOIIfIf.ro �,,�,LI CATI O N
; F�n�c w�r,we 9sos�- r�i�OF FEDER
ss3-assseo�•F,txss3-aas-a� BUI�DING Q / !
•_•��v.dtuo/M'e�rdva4 mm '
` :�1���-
� The ollowt {s re {red in o tion-an nce lete a licatton wtil not be acce ted. Piease rtnt le 1 in t or e.
-• • � • - •
SITE ADDRESS '
p� / SUITE/UNIT#k �_
ASSESSOR'S TAX/pARCEL�k � O � ( � - � � � � LpT SIZE(s,�
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1 J �
��
_, /Attaah aeparate page far MgOWlqp�dewipyo^/
•� • ' •
TYPE OF PERMIT O BUILDING O PLZJA�ING O MECIiANICAL -
❑ DEMOLITION CS ELECTRICAL ❑ ENQINEERING�FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Prouide detailed description of work irtc(uded on this oerntit on,(u)
( . �) .
M •� �
� �—�e"o� "-� � A �'��.�a a�a
�
�
�
[ PROJECT NAME(Name of Business or Owner Last Name) { � `
� � • � � � .
PROPERTY NAME � PRIMARY PHONE
OWNER . �� � ��� (4t2�'� /
rs, - i'i
MA1LINa ADDRES CITY,STATE,ZIP < r � '�
�. ` � j W �i�stJ�`.�.
� CONTRACTOR �MPANY NAME \ APPUCANT NAME OFFICE PHONE
` �s��✓ C�� �:E�,G�b� ��� �Z�- t��F,�
MAILiNU ADDRESS , C1TY,STATE, CBLL pHONE
� 1`C� .►7 ::��.+c�MJ�+ZI�.^� � . �--. `.�1��.��
� Cf1Y OF FEDERAL WAY BU3INESS WCENSE NUMBER � ����� �^���
EXPIRATION DATE .:/ FAX MJMBER
�� 1 °�.-��-1 �� �. �s �-B� �, � 1�� � /o� (z�3) ���- �� I
CONTRACTORS REQI3TRATION NUMBER(eop�of eud reqalred with each appLLcation� EXp�RA'p(ON DATE
C l.. z� �J E = �.�a �Q1,� l_.� �/—� /��,
APPLICANT COMPANY NAME APPLICANT NAME ORFICE PHONE
�c���C,
i � � _
� ' MAILINU ADDRESS CITY,STATE,ZIP ' CELL PHONE
RELATIONSHIPTO PRWECT � "
FAX NUMBER
❑ Architect ❑Tenant ❑Agent ❑ Other(DescribeJ � � _
CONTACT NAME PRIMARYpHONE E-MA[LADDRES3
� ����k SC�'� c;>"'��2, - ���ic Gv yr...�.� ���M�c ,o�.�
LENDER wU,RE
I
MAILINO ADDRES3 Cf1Y.81'ATB,Z[P
� � � : 1 � • ' •
` EXISTING USE PROPO$ED USE
I
� EXISTING ASSESSED/APPRAI$ED ypI,IIE � VALUE OF PROPOSED WORK S�
SPRINKLERED BUILDING? ❑YES ❑NO FIRE SIIPPRESgION SYSTEM PROPOSED/REQUII2ED? ❑YES ❑ NO
� •
; WATER SERVICE PROVIDER p LAKEFIA{�EN p HI<}HI,INE p TACOMA p pgNATE(WELL)
SEW.�R SERVICE PROVIDER O LAI�HAVEN ❑HIGHLINE 0 PRIVATE SEPTIC)
-. . • -
AREA DESCRIPTION EXISTING PROP03ED TOTAL
8 .FT. S .FT. S .FT.
BASEMENT �
�
FIRST �
SECOND 1
'ffiIRD
FOURTH ' •
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE O CARPORT❑
i7QSTpfO �ROrOS6D 70TAL : "' . ; _,. :R..._.._.__....:3R,. . .�..._�:�} .. .
NUMBER OF FLOORS
`•NEWHOMES ONLY'" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
► �
Indicate number of each type of fuchcre to 6e insta!(ed or relocated as part of this project. Do not iru;lude existing fudures to remain. �
�C,FiAMG`AL +
Value of Mechanica!Work $ �
� �
AIR HANDLING UNITS EVAPORATIVE COOLER$ UAS LOG3 REFRIQ.SYSTEMS �
BBQS FANS Fi00D3�com�,d.q WOODSTOVES
BOILERS �.,. FIREPLACE INSERTS RANQES ` '= M[SC(Describe� �
� COMPRE330RS FUI2NACES GAS WATEIt HEATERS
DUCT3 (3A3 PIPE OUTLET3 '
PLUMBING
BATHTUBS(erhb/ShauerGmbo) 3HOWERS WATER CIASE'PS Rotkq MISC(Describe) ��
DISHWASHERS SINKS DRINHINC3 FOUNTAINS I
UAS PIPE OUTLETS SUMPS RAINWATER SY3T �
WASHINa MACHINES URINALS H03E BIBBS
I.AVS(9.throomstdc� VACUtJM BREAKERS ELECTRIC WATER AEATERS �
� � i
�I cert�y under pena(ty of perfury that the ir{formatton furn{shed 6y ine is du�and correct to ths best oj my knowiedge,and further,that I �
am aathorised 6y the owner of the above premises to perform ths work jor ruhich the permit appiteatton ia made. I further agrss to ho(d
harmlass the City of Federal Way as to any cialm({nciuding costs, expenses, and altorneys'jess lneurred In ths investigaHon and dejense oj
such clai�,which may 6e made by any peraon,!nc(uding the underatgned,and filed against ths City ojFedarai Way,but oniy where such clafm
arises out of the reltance of the city,inciuding{ts offlcers and emp(oyees,�pon the accuracy oj the ir{(orrnaHon supplted to the city as a part of
thts appiicatton.
J
NAME/TITLE � ( DATE �����,
.. ign urc) C►YUd ' 1
RELATIONSHIP TO PROJECT r ❑Agent O Contractor ❑Architect ❑ Other �,
I
i
. �
�
_ I
�
�
_ i
i
�
,
�
Bullettn#100—Janusiy 7,2pp5 . Page 2 of 4 k�Handouts�Permit Application