01-103192 arum CONSTRUCTION PERMIT APPLICATION
3Fr N D APPLICATION NUMBER: Q f - 1 031/Z =PFI
APPLICATION NUMBER: - -
AUG 13 2001 APPLICATION NUMBER: _ — — — — — -
**The VIRVI ;'V-P 'L WAMIQfl atlon—Please print(in Mk)or type**
Please note: ®ethical,Fire Pr and Engineering permits may require a separate application.
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(J �, ,�/■ PROPERTY INFORMATION
SITE ADDRESS: �(D 10 f AC.F�. W/ Scam ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
• PROJECT INFORMATION
TYPE OF PROJECT(This application): a BUILDING a PLUMBING a MECHANICAL o DEMOLITION
a ELECTRICAL a ENGINEERING VIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed desaiptlon):NW-PA t 312, P-lke SPRINk LErt SYSTEirt1
(Pti6oii f &ti0011)
PROJECT NAME: RAU.ITHE L MO it S.01 I'E S
• PEOPLE INFORMATION
PROPERTY OWNER: NAME: wDAYRMEPHONE:
InuE3T+n�►F,�tss (so�)92.f- 3-71.61
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
3O51 AC. S v/M Rip( 6(.64. 34, Stole i tN' 92 t
CONTRACTOR: NAME: CAM/ F' E sfgAt4kLE tlJC. (503)168 -StOO
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
%PG W ILSOM ST'II t36En/w1 OR, c?D.1O . (s03)c139 $009
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
(cOS)96V to
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
,1DEx51. 1 isiO 3 / g / O2
APPLICANTS NAME. 1 � DAYTIME PHONE:
Jeff NI ( ) Sh.&
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
spfm. ( ) SSE
RELATIONSHIP TO PROJECT: . FAX NUMBER:
o ARCHITECT a TENANT gLOTHER(DESCRIBE):aftk. (WTI... ( ) sh.me
E-MAIL ADDRESS: M
CONTACT PERSON FOR Tills PROJECT: a PROPERTY OWNER a APPLICANT gCONTRACTOR \INTO E I'FQAOC,Co
• DETAILED BUILDING INFORMATION
EXISTING USE: ElaSTING BUILDING ASSESSED/APPRAISED VALUATION $ Qp
PROPOSED USE: td1FL PROPOSED VALUATION FOR IMPROVEMENTS: $ "'�(1S'9 119.00
SPRING/RED BUILDING? o YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:AYES a NO
WATER SERVICE PROVIDER: a LAKEHAVEN a HIGHLINE a TACOMA _a PRIVATE(WELL)
SEWER SERVICE PROVIDER: a L ICEHAVEN o NINE 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:
• FIXTURES
Indicate number of eadi type of fixture
MECHANICAL
AIR HANDLING UNITS) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEMS)
BBQ( FAN(S) HOOD(S) WOODSTO
BOILS(S) FIREPLACE INSERT(S) RANGE(S) MISCVE(S)
COMPRESSORS) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE:a ELECTRIC a GAS
PLUMBING
BATHTUBS) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHERS) RAIN WATER SYS. VACUUM BREAKERS) a ELECTRIC o GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINKS) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
■ DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the adorn ation fumld ed by me is true and coned to the best of my knowledge,and
further,that I am authortted by the owner of the above premises to perform the work for which the perm It application b made. I
further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees Incurred in the
Investigation and defense of such claim),which may be made by any person,including the undersigned,and fled against the City of
Federal Way,but only where such dais arises out of the reliance of the dty,hncldhg Rs officers and employees,upon the accuracy
of the heorttAsuppiled to the city as a 7
of this application.NAME/TITK.E: M• fPu /�l( DATE: a/ /61
o PROPERTY OWNER a APPLICANT )(CONTRACTOR cQ