04-100723 f , '` aF P5
Wa =
RECEIVED CONSTRUCTION PE MIT APPLICATION
APPLICATION NUMBER: D - 4. 0.0 Z 23- I
MAR 1 2004 APPLICATION NUMBER: - a _ _ - — *�
CITY OF F EDER�ApL.WAY APPLICATION NUMBER: _ _ _ -
"SiglithilillIsbigli required information-MOMS print(in Ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
SITE ADDRESS: .i IL/5.5 2gl k A,C• SCA/111 ASSESSOR'S TAX/PARCEL it: z L Ca - q U Z a
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OP PROJECT(The$application): o BUILDING ❑PLUMBING ❑MECHANICAL o DEMOLITION
a ELECTRICAL a ENGINEERING OAR,PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): 311 I# ,v I Al.,- Fi/r A f c cii Sy`d 1em .
` . J Ss /A-
.RNa�ECT NAME: F��p,.ti l �/1/NII P u
OMYT1eE hiol+E
r PROPERTY OWNER """ �S F S1) P(il�i Sa✓,,d Z S/� 1 ( 206)`�3�J -6 °!2 Z.
NAILING ADDRESS(STREET ADDRESS;CITY,STATE.Ilk /A /[
qo0 SW i57 NJ c Vee . , &c;eh l'VA r'O I 6V
NAME: DAYTIME PHONE:
CONTRACTOR: \�// / (12 )'/,Sy -Z
M'LING ADO RES-(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:2 S 'i i G, r 3®N�E. ./V 1 N . S c -c 4 vv4 *07 ? ( Nun -
:
CITY OF FEDERAL WAY BUSINESS NUMBER: - - ( ) _
axflIL CTOR'S REMSTRATION NUMBER: EXPIRATION DATE:
(copy d did rtqlrad)
L L_ igi .- L Z 61- 6- l I
DAYTIME PHONE: �j y
NAME: (2O6)2 GI/ - [J de
APPLICANT: -��s fiR in 1�i-�"�I�� `-5 �rn �x C-��( An t�
MAILING ADDRESS(STREET ADORES;CITY,SLATE,ZIP): EVENING PHONE:
(2v6 ) 73o -;?Oi 7
RELATIONSHIP TO PROJECT: FAX NUMBER:
-
❑ARCHITECT ❑TENANT OTHER(DESCRIBE):_1/1 t. ( )
E-MAIL ADORESS:
CONTACT PERSON FOR THIS PROJECT: ❑PROPERTY OWNER APPLICANT ❑CONTRACTOR
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ / 'I'O OV ---
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑YES ❑NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: 0 YES ❑NO
WATER SERVICE PROVIDER: ❑LAKEHAVEN o HIGHLINE o TACOMA ❑PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑LAKEHAVEN ❑HIGHLINE ❑PRIVATE(SEPTIC)
-
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ 1'tili)1E(
FLOOR EXISTING SQ.FT. PROPOSED SQ FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL
■ ,
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIR.SYSTEMS)
PANS) HOOD(S) WOODSTOVE(S)
ISR(S) FIREPLACE INSERT(S) RANGE(S) ___„r MISC.( )
COMPRESSORS) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) NEAT SOURCE: ❑ELECTRIC Q GAS
PLUMBING �Y
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ELECTRIC ❑GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( ---_- )
INTERCEPTOR(S) SUMP(S)
G , n.
I certify under penalty of perjury that the information furnished by as Is true and correct to the best of my knowledge,and
further,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 Wry as to any dales(Indudlg costs,expenses,and attorneys'fess incurred In the
Investigation and defines of such dei n),which may be made by any person,including the undersigned,and fled against the City of
Federal Way,but only where such cabs*rites out of the reliance of the dty,Including its officers and employees,upon the accuracy
of the information suppled to the city as a part of this appikatiop.
NAME/TITLE: '4 /44 DATE: ?A/ /
o PROPERTY OWNER ❑APPLICANT ❑CONTRACTOR
FOR OFFICE USE ONLY:
❑NEW ❑ADDITION ❑ALTERATION a REPAIR a TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION: BUILDING SHELL ONLY? ❑YES ❑NO
COMP PLAN DESIGNATION BASIC PLAN? ❑YES ❑NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑YES ❑NO
PLATTED LOT? ❑YES ❑NO CHANGE OF USE? ❑YES ❑NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718.253-661-4000•FAX:253-661-4129