00-105960 A R
f 1.1
aT2104- . CONSTRUCTION PERMIT APPLICATION
FlY DEC 1 1 MOO APPLICATION NUMBER: -
APPLICATION NUMBER: -
GIP(OF FEDERAL WHA
BUILDING DEPT, APPLICATION NUMBER: - -
**The following is required information-Please print(in ink)or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
• PROPERTY INFORMATION
SITE ADDRESS: 22SQ S. 320 301/4 ASSESSOR'S TAX/PARCEL#: 2- 9 2.. 3 2 O - 0 0 5 Q
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
• PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING o PLUMBING o MECHANICAL ❑ DEMOLITION
o ELECTRICAL o ENGINEERING paIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): ����r � \ ,��. c ov.vk1Co.rt \-ke
PROJECT NAME: �c "Np`�.off,& CIN, r C,R,t ctItk.
• PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
- '�f c �+��+_` `.. t (2.53) 8 S'Z-
MAILING ADDRESS(STREET ADDRESS;CtrY,STATE,ZIP):
1011.0l$ \c o.NACl a V _Q SC3- 1
CONTRACTOR: NAME: DAYTIME PHONE:
G 4s1n)i t-�,'?� c r-c-rrc (253)"� 31- - 2-1,4b
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
122n -61, Ok.il . i Cta. (2S's) .� 3"� 2.Zo6
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
- 1 Q 1 'i 5 - L ( 273) 31 - -2:30 I
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
LU .E ? I 33 LE )7 / 3I / Cod
APPLICANT: NAME: DAYTIME PHONE:
Cl eau"' (3.53) / 2-2-((O
MAILING ADDR (STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
Saves As A (25 ) 131- 22.d0
RELATIONSHIP TO PROJECT: /� FAX NUMBER:
0 ARCHITECT ❑ TENANT iHER( DESCRIBE):00s. c T,4 c (2'53)13 2301
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER Liz"'PLICANT o CONTRACTOR qA.0 � -}-ycp t,�� Ccr.
• DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: C ' C vs.L PROPOSED VALUATION FOR IMPROVEMENTS: $ 'Ja
SPRINKLERED BUILDING? "OYES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ES o NO
• •
WATER SERVICE PROVIDER: o LAKEHAVEN ❑ HIGHLINE o TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER: o LAKEHAVEN o HIGHLINE o PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• PROJECT FLOOR AREAS
FLOOR EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL: 1 3 30
• FIXTURES
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGES) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) o ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) _ WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
• DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge,and
further,that I am authorized 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(including costs,expenses,and attorneys'fees incurredin the
investigation and def e of such claim),which may be made by any person, including the undersigned,and filed against the City of
Federal Way, but on here such claim arises out of the reliance of the city, including its officers and employees,upon the accuracy
of the information upp ied to the ity as a part of this applicazrecileta
tion. // �
NAME/TITLE: Gt •-"" KY Mr 'fW DATE: 0---//
o PROPERTY OWNER APPLICANT o CONTRACTOR