06-100030 ����iv��
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Feder�ai Wa� �� - � �����
PERM�'�'Y OF FEDERAL WA�YF MF CO ME EL PL DE E FP
� cb�uemrnsyscoP�rrsenvtcss BUILDING DEPT.
, 999?5 dTMAVBNUS SOU17/•PO BOX 9778 A P P LI C AT I O N
FBOBRAL WAY,WA 98063-9918.
� Y53-Q95-7607•PAX 253-d35•?609
t�w.dtuoli'ederohuau.mm
� The oliowing is {red it{formatton-an inco iete a licatlon wiii not be acce ted. Please rint Ie ibi in in or
� pe,
� -• • • • •
SITE ADDRESS GL�� ` 3UITE/iTNIT� _�
f ASBESSOR'3 TAX/PARCEL� _ _ _ _ _ _- _ _ _ LOT 3IZE(s�
� LE(3AL DESCRIPTION(e.g.Acme Estates,Lot 1) • •
� leamn+�aw�a��aiwt�gara..or�1 •
-• • - •
TYPE OF PERMIT ❑BUILDIN(i . ❑ PLUII�ING O MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ EN4INEERINQ pJ FIRE PREVENTION SY3TEM
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; PROJECT DESCRIPTION(Arovide detai(ed description of work included on this permit onlvl
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; PROJECT NAME(Nume of Business or Owner Last Name)
• • • • • .
PROPERTY NAME � � �'PRIMARY PHONE
OWNER -% _ � � "
MA1 N� R -�
A�E,
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CONTRACTOR �MPANY NAME . APPIICANT NAME ' OFFICE PHONE
'r� � ���z - �
INO A DRE3S ,9TAT&, P CELL PHONE
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OF FEDERA AY BUSINESS llC8N3 NUMBE PI ION DATE FAX ER
�t�--�a='-.l�� —.� 'B L �-��� � l� � �� -O ��
CONTRACTOR9 RE(3ISTRATION NU B&R(co ot cud r aired wlth afich�pplle�tion� FaCPIRATION DATB
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APPLICANT COPdPANY NAME APPLtCANT NAMB OFFIC&PHONB •
/ �� " �
ADD E3S CITY.3TATE.ZIP CEIJ.PHOIYB'
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REWTION3HIP TO PROJECT FAX BER
❑Architect ❑:Tenant ❑Agent ❑ Other(DescnbeJ ( � _
CONTACT �ME PRIMA PHONE � � E-MA[L ADDRFS9
Gt�1� Q 1't- rZ,D _ �-.
LExnER NAME
MAIUNO ADDRESS CITY,STATB,ZIP PHON&
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� � : � • ' •
ERISTIN(3�USE � 1�GL� PROPOSED II8E '� C �L�
• � ,.
EXI3TINf�A33ESSED/APPRAISED VALUE S� � � VALUE OF PROPOSED WORK � ��G��L•r�
SPRINKLERED BIIII.DIN4? []YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED%REQUIRED? �YES ❑ NO
WATER SERVICE PROVIDER LAKEHAVEN O ffiGFII.INE ❑ TACOMA O PRIVATE(WELL)
SEWER 3ERViCE PRAVIDER����,ILAKEHAVEN . ❑ ffiGHLINE ❑ PRNATE(3EPTIC�
-• •• -
� AREA DESCRIPTION EXI3TING PROP03ED TOTAL �
3 .FT. S .FT. 3 .FT.
BASEMENT
F"IRS"f
1
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
(#ARAGE ❑ CARPORT❑
saesdo rxorwso me�a.
NUIvIBER OF FLUORS '
•'NEWHOMES ONLI'*' NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ '
I
f e o re to be instaUed or relocated as art o this� ro ed. Do not include existin �res to�emdin. �
Indicate number of each yp f fixtu p .f p J 8 f��
MLC,FIAIITICAL I
Value of Mechanical Work $
AIR HANDLING UMTS EVAPORATNE COOLERS (iA3 LO(33 REFRI(3.3YSTEM3
BgQg FAN3 HOOD3�cemmerd.p WOOD3TOVES
BOILERS FlREPLACE IN3ERTS RANdES . MI3C(Descdbe)
COMPRE330RS � FURNACES GA9 WATER HEATERS
.DUCT3 (3A3 PIPE OUTLET3
PLUMBING �
BATHTIJB3�o�nn/sno�cembo► 3HOWERS ' WATER CL03ETS�ro�q MISC(Describe)
DI3HWA3HE123 3INK3 DRINKINC}FOUNTAIN3
dA9 PIPE OUTLETS _T 3UMP3 RAINWATER 3Y3T
WA3HINd MACHINE3 IJRINAL3 H03E BIBBS
. LAV3 athreem VACWM BREAKER3 ELECTRIC WATER HEATERS
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I cert{jy under psnaity of p�rjcery that!he ir{formalton jurnished by�ne ts true and�"rrect to the best of iny knowiedge,and Jwther,that I
am authorlsed by the own�r oj ths abom pnmtses to p�rform the work Jor whic s permt!appitcatlon is.inade. I further agr�s to hold
harmlus the City oj Fedsrai Way as to any elatm/includtrig costa. expsnses, an rneys'fses tncurred in the investigatton and dejense o,J
such ciain�,which may be neade by dny penon,includtng the understgnsd,and e' agatnst iht City oj!'ederai Way,but oniy where such Tatm
arises out ojthe nitance ojthe ctty,includ{ng its offtcsra and etnpiogss u t accuracy of tha i�forneatton supplted to the ctty as of
thts atppiicallon.
NAME/TITLE DATE ���—�
i m�i
12ELATIONSHIP O T q er 0 Agent ontrac O Architect �Other
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