06-103296RECEI V EL
CIr7 aF
F'ederal•Way JUL 0 3 Z006 PERMIT
COMMUNt7YDEVF.WP1dF.N7SPRVIM
33.725 8Fr Rm, W p SWA 9 PC1 971 9713 APPLICATION
Fl;n+�r�ar, WAY, WA 9aa6s.s7ra . - 4. f=�DERAI
251-835-2607• FAX 253•83S•2509I l �.0ING ❑ L I
The following is
- an
will not be
SF M& ME EL PL DE EN FP
Ited. Please print le_0bly fin ink) or type_
SITE ADDRESS 3 ( C(, r �SSUITE/UNIT #
ASSESSOR'S TAX/PARCEL # � j 2 d Q 2'� - a I LOT SIZE (s�
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) S"ri • D QZ) 6c� i'px LOT ?—?I La-1 I ( i
(Aifaah A' pW se~1I ImOhg legal deaaWON -
TYPE OF PERMIT BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
'PROJECT. DESCRIPTION (Provide detailed description of work included on this permit on1U/
�(_c S��r= C �1c 7 �s A�fr I rc�ci
cLi`005
PROJECT NAME (Name of Business or Owner Last Name)
PEOPLEO•
—PROPERTY NAM PRIMARY PHDN&
OWNER n �O i'S (G)`
MA1L ADDRESS CITY, STATE, Z1P
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
AILING ADDRESS Y. STATE, ZIP dvr,115
CELL PHDNS
ns•lais nu,.iSE - F1 T FA?C HUMHSR
CONTRACTORS REGISTRAT[OH NUMBER (aepy of and required with a}rL ■ppE-01e1-1 EXPIRATION DATE
APPLICANT
�l.... nvUKC-JA•
l o � � 4 C�r�l� A�--sy�•
❑ Architect ❑ Tenant 0 Agent ❑ Other (Describe) —
CONTACT
LENDER
EXISTING USE
EXISTING ASSESSED/APPRAISED VALUE $!//
SPRINKLERED BUILDING? ❑ YES ff�'NO
WATER SERVICE PROVIDER &LAKEHAVEN
SEWER SERVICE PROVIDER dLAKEHAVEN
(.zL, 3) qq'i - 6tw,
CELL PHONE
(2-6&)17t73 = /7S�SS
FAX NUMBER
(z,06) q(Ll - I
PROPOSED USE �ANI �TL�=oVc.L6QC�
VALUE OF PROPOSED WORK $--
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YESvb
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
0 HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DICK (COVERED)
GARAGE ❑ CARPORT ❑
NUMBER
ONLY*" NUMBER OF
rl[opoesn I TOTAL
EXISTING
SQ. FT.
PRICE
PROPOSED TWA'
SQ. FT._ 1 -,54. FT.
Pn to number of each type of fixture to be installed or relocated as part of this;project. Do not include existing s to remain.
MECHAWCAL
Value of Mechanical War Y; -
AIR HANDLING UNITS _ EVAPORATIVE COOLERS GAS Lp(.} REFRIG. SYSTEMS
BBQS _ FANS(enmmere�el) WOODSTOVES
BOILERS PLACE INSERTS RANGES MISC (Describe)
COMPRESSORS TURN GAS WATER HEATERS
DUCTS GAS PIPE
BATHTUBS
MACHINES
LMAK
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
CLOSETS rr.11.q
DRINKIEG FOUNTAINS
HOSE BIBBS
ELECTRIC WATER
MISC (Describe)
I cert(fy underpsnalty of perjury that the informatior, furnished by me is true and correct to the best of any knowledge, and farther, 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 (inctudinj costs, expanses, and attorneys' fees incurred in the investigation and defense of
such claim], which may be made by tiny person, Including the undersigned, andfiled against the City of Federal Way, but only where such claim
arises out of the reliance of the city, including its officers and employees, the accuracy of
this application, pthe information supplied to the city as a art of
NAME/TITLE DATE
(Signsturcl (Title)
RELATIONSHIP TO PROJECT Q Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other
RIlIletln 3!1 AQ-Tanuarv1 7nn6 Pam- 2ofQ 1.%..__I_- ,