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Thela[b�oing ts requir�ed i�nad�-an tncornpiete appttcabtai wut not He a«:epred. Pteaas prtnc tegtety(tn inW or Krpe.
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ess�ssoa•s Tex�r�c�.�r —— — - —— —— i.o�r s��5.�
IF�QAL DEBCR�TION(e.g.Acnee Estates.i.ot 1)
�nm�..�vre���na,�+�.�mm�
T'YP�OF PER11�T ❑HiJII DII�iCi ❑ PLII1�II�i(i ❑ MBCHAMCAL
O DEMOLITION 0 ELECTRICAL ❑ EPi(iII�iEERIIrQ��FIItE PREVLNTIOPi SYSTEM
PROJECT DEBCItSTION(Proukle detatled descrtptton of uwrk included on this nertnit onlul
�i.v A L �c,a� u r� o � ��P� �i,�i:.o .��R.4.v NA��NS�L L
�i4��L �on� /"i�i� Sui°�o.��;,,�'S�a�.Ls v 5;;��w�,.
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PROJECT NA�(Name of i�s ness or Owner�Namel �r-� ,�.� �o�4.,���rN s
.
PROPERIY �'� - � H
OWNER y � -
MAILIIV ADD C .STA1E.7.tP � E-MAIL ADDRESS
CON7`RACTOR COME'ANY NAME APPIICANI'NAME OF'FRCE PHONE
/q/� l l2�;. S�1/�H�" STI-�� ST.2�TN/s.2 (206 )Z� -1721
AADRESS Cr1Y,STA1E.Z� CELL PHONE
30�3 ,eo �,� s���7� �io �2S31 Zaz -?ZS�
CifY OF FEDERAL WAY BUSINESS LICENSE NUbIBER E]{PRiA1ION DA1E FAX NUMBER
�o '_�'c� - 3 - c�c� - /�t- ( ) '
CONIRAR)TOR'8 Yl6ti ltOI�EA 6ZPRtA1I0A LATS �MAII.ADDRESS
star- �s.r � o �os �� -�
�I� CObtPANY NAME APPI1CANf NAME OFFYCE PHONE
S/�YNI✓ � � '
MAILING ADDRF9,S C[lY,5fA1E,ZQ> CELL PHONE
� � '
REIA'RONSHIP 1�0 PRQJECT FAX NUMBER
❑Architect o Tenant ❑Agent ❑ Other ( ) -
PROJECT � r�xr rt►oNE E- nnnxess
coxzec�r S�/��/� STi7uit✓,�/L ( ta3� t�Z, - 7Z
LFNDI�R rinME rier�Civls.a7.o9a:
Lender ir}f'ormatinn ia requtr+ed�j'pnqject vailue e�rceeds$8.000
MA11�IG ADDRESS Cr1Y,STA1E,7dP PHONE
l � '
� •
EffiSTII�iG USE PROPOSED USE
�sTnvc�ess$sssn�arrx�sEn v�S vnu�oF rRopos�n wox� S /2 2 d
SPRINSLERED BIIII UING? ❑Y88 � NO FIRE SIIPPREBBION BY$TEM PROP08ED/RE9QIItED? �YES ❑ NO
WATER SERVICE PROVIDER ❑ LAHffiAVEN ❑ ffiGHI.iNE ❑ TACOMA ❑PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ I1IHLAAVEN ❑ffiGffi I1VE ❑ PRIVATE(SEPTIC)
ARF.A DEBCRIPTIOPi E%I81'II�iG PROPOSED TOTAL
.FT. .FT. .FT.
BASEMENT
FIF2ST
SECOND
'I'IiIRD
ADDP170NAL Ff.00RS(DESCRIBE)
DECK(O COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUM$ER OF FIAORS '�� �� '�� "�'���"�� '�'���� '�'��`�
'"NEW HOMES ONLY"' NUMBER OF BEDROOMS EST[MATED SEI,LING PRICE $
r►uttcare number Qf each type qf,f�cture m be b,stalled or retocared as parc o,jvUs prqJect no nor rnctuae exrsany,Jixau�es m remaln.
D�CFL�NICAL
Value of Mechanlcal Work$ (A COPY OF BID OR ESTYMAIE MUST BE INCLUDED Wf1I3 APPIICAT7011D
AIR HANDLIN(3 UNCfS EVAPORA'IIVE COOLERS GAS PIPE OVILETS WOODSPOVES
BS9S FANS (}AB WATER HEA1'ERS MISC(Descrlbe)
BOILERS NYREPIACE INSERI'S HOODS�coam��.dep
COMPRESSORS NVRNACES RANGES
DUCTS GAS IAG SE15 REFRIG.SYSfEM5
PLL/MBIIVG
��N�lar mb/shower comeol IAVS�eatn,�m s�nra� UR[NAIS MISC(Descrlbe)
DISHWASHERS RAINWATEFt 3YSf VACUUM BREAKERS
DRINKING FOUNfAINS SHOWERS WATER CLOSEIS Rmrep
EIF,CTRIC WATER HEAIERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
. .
I�4hI�►'P�►��4/�P��'!I that I mn the property ounter or autltorisrd ageni qf the property oumar.I cert�fy that to the 6est 4f mU
kmwnled9e� the ir4f'ormation submitbed in suPPo�Rf this permit application is true mid c»rrect.I cert�f'y that I will oompty wtth aU appiicaMe
�f Rf Fiedernl Way rogulMinns pertaining to the work authortsed by the issuatece q/'a permii.I understand that tite tasuonce qJ'tltis per'rttit
anes�ar r+emaue cne oumers nesponsibtliter.ln*oompltance�oirn local.acate.orfedennl Imo�s.�pulaetng oonsd„ccton or en„tnunmencal eaoe.
r furcner agree ro nnea na.mle�ens cxey of rfsaerw way as w w�y�tatm(tnci�ccu,ng oo�s,expenaes. ana atro�,ee�s•jces tnc�nea tn cne
inuescigatiort and dqfenae qf such cl��N. which ma�l�made b�l�l P��. ��u+�9��►�8�+ �.1i�a9�nat the dty,but oniy
where such claim arisea out qj'the reltance of the ctty.including its o.�Rons and emP�. �P���Y 4f the t�O�mation suppUsd to
the city as a part qf this appltoation.
SIGNAT'[JRE: `..J DATE �—��d 7
Property Owner and/or thorized Agent
FOR OFFICE II8E ONLY
a NEW ❑ADDITION ❑ALTERATION ❑REPAIIi ❑TENANT IMPROVEMEPiT
BUII,DING SHELi.ONLY? ❑YE8 ❑NO BASIC PT.AN? ❑YE8 ❑NO
ZONII�1(i DESI(�NAATION CHANQrE OF IISE? ❑YES ❑NO
NEW ADDRE$S RF�UIItED? ❑YE3 ❑MO UP/SEPA/8II? ❑YEB ❑MO
PLATTED LOT? ❑YES ❑NO DEMO PERAIIT RF�$[JIItED? ❑YEB ❑NO
Bulletin#100-August 16,2007 Page 2 of 4 k�FIandouts�Pernvt Application