06-100189 f / A .
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, Federa�way PERMIT
• coeanJxm�nEVEwrn�xrsexvices SF MF CO ME EL PL DE E FP
3���A`�"`�s°�'f.��9"��;� 1 � `��PpLI CATI ON
rrnErsai,war,wn seoss-s�is /
253-835-2607•FAX 253-835-2609
wwu+.ctNo(federalu�au.c��TY�OF I-EDERAL WAY
The ollowi is �an lete licatton u�ill not 6e . Please t (in ink)or
•• •• •
SITE ADDRESS �I� l- I � �-✓G+' d L/.�(�7 SUITE/11NIT M
ASSESSOR'S Ta9g/PARCEL# �— — — � � � LOT SIZE(s.�
LEGAi.DESCRIPTION(e.g.Acme Estates,Lot 1)
Uuacn s�ma�yayel�+���o
'• •
TYP'E OF PERMIT ❑BUII.DII'iG ❑ PLUMBING ❑ MECHANICAi.
❑ DEMOLI140N ❑ Et n'f"rRrC�Ai. ❑ ENGINEERII�iG�FIRE PItEVENTION SYSTEM
PR DESCRIPTION ouide deta�led descriptinn of work ir�luded on this i#onl
Y � ' �c'j'' �% ` �f
e. 'r � O
PROJECT NAME(Name of Business or Owrter Last Name) �(T � � � � ' �
• • •• •
PROPERTY PRIMARY PHONE
ow►�rEx Ci 'C' P Cr` ) 1�'-' c
MAILING ADD ,SfA
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COKTRACTOR COMPANF NAME APPllCANT NAME OFFICE PHONE
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MAII,QVG ADDRFSS . CP1Y,Sfi11E.Z� CELL PHONE
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C11Y OF FFAERAL WAY BtJSINF.SS IdCENSE NUMBER EXPiRA110N DA1E FAX NUWBER
� Q- o s=L Q .��-t�-B L ' 3 � d c � -
CONIRAC7'OR'S REGISTRA170N NUMBER( ot vired wlth e�ch appLcation) E7�IRA110N DA7E
5 Q 1.�. 5_ � (� / /
a�cnxT CO�°�""� U i: J fL1Un'T �P � N �Q�P ���E�o� _�Q/
G ADD . C .SCA1E. CELL PI-IONE
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REIA170NSHIP 7'O� f� /Y gyg�7��g
❑Architect o Tenant ❑Agent Other/Describe)_�j/`J C df'I � ( ) -
CONTACT N PRI PHON - ADDRESS
Cl�fi�J . ) - � ✓{ l'
�xn�t �xcw ia.a�.oea: zenaer t.y�o,maeton�a N^"� �y�� , d
1 requb+ed�fPnuj�t votue eacooe�as$s.000
MAILING ADDRESS C11Y.5fA7E.TdP � PHONE
, � � -
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E7�STII�TG IISE PROPOSED IISE t� � �/P
�srnvG essEssEn/�rx�sEn v� S vnLUE oF rxoposEn wox� S ��
SP'�IRINKLERED BIIII.DING? ❑YE3 �NO FIRE SIIPPRESSION SYSTEM PTtOPOSED/RE$UIItEDT ❑YES �NO
WATER SERVICE PROVIDER ❑ LAKEBAVEN ❑ HIGHI 1NE ❑ TACONA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ I.AHEE�AVEN ❑ ffiGHLIIiE ❑ PRIVATE(SEPTiC)
.
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.
• . .••
ARF.A DESCRIIiTION ESISTII�iG PROPOSED TOTAL
.FT. .FT. .FT.
BASEMENT
FIRST
SECOND
1Z-IIRD
FOURTH
ADDIT]ONAL FI.00RS(DFSCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
NUMBER OF FLOORS �rn�o reaeo� mre�. mrecmermaar rare�.n�aro�• rore�.v
••NEW HOMFS ONLY" NUMBER OF BEDROOMS EST7MA'IED SELIdNG PRICE $
Indicate number of each type of_f?xture to be lnstalled or reincated as part of this project Do not'vtdude exfsting fixhues to remairt.
�1TICAL
Value of Mechanlcal Work $
A1R HANDL[NG UNITS EVAPORATIVE COOLERS GAS I.00S REFRIG.SYSTEMS
BBQS FANS HOODS�comme,cuq WOODS7'OVE,S
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS �JRNACES GAS WATERfiEATERS
DUC1'S GAS PIPE OVCLET'S
PLUMBING
BATHTUBS(or'lhb(3hower Comho) SHOWERS WATER CIASEIS(7tf�eq MISC(Descrlbe)
DISHWASHERS SINKS DRINKING FOUNfA1NS
GAS PIPE OU'ILE1'S SUMPS RAINWATER SYSI'
WASHING MACHINFS URINALS HOSE BIBBS
LAVS�aauuoo�sml�s) VACUUM BREAKERS ELECTRIC WATER HEATERS
� •
I cert(jy under penalty oj per}ury that the ir}fm�matton Jundsh�by me is true and oomect to the 6eat of my knn�uledge,and further.that I
am authorlaed 6y the ourner qf the above premises to rm the uaork jor rahich the pmnit appiication is made. I further agr+e�e to hold
harmiess the City of Afedera!Way as to any cl �y�rs.���.a�acw�ys•,�t�.�,ga tn cne t�c�aaton�a a4f�af
such claim).which mcay be made by pe�son, the undersignad,and,�ited against the(xg�ojPlederal Way.but only urhere such claim
ariaes out qj the reltance city ludiTMg and employees.upon the aecuracy of the iH'ormation supplied to the city as a parc qf
Mis applicatinn.
KAME/T1TLE DATE / ✓� �Y
�gna[ure1 (77Ue)
RELAITON&HIP TO PROrJF.CT ❑ Owner ❑Agent �Contractor ❑Architect ❑ Other
/\
FOIt OFFICE IISE ONLY
❑NEW ❑ADDITION ❑ALTERATION ❑REPAIIt ❑TENANT IMPROVEMF1�iT
BUII,�INf3 SHELL ONLY? o YES ❑NO BASIC PI.AR? o YEB ❑NO
ZONIIYG DESIQNATiON CHANOE OF USE? ❑YE$ o NO
NEW ADDRE88 RE9VIItED? ❑YES ❑NO DP/S�EPA/8II? ❑YEB ❑NO
PI.ATTED LOT? ❑YE8 ❑NO DF.,[O P�RffiT RF.9IIIItED? ❑YES ❑NO
Bulletin#100—January 1,2006 Page 2 of 4 kU�andouts�Permit Application