03-104401 05/29/2001 13:29 FAX 2536614129 CITY FEDERALWAY ?a' 1-01-so lr'DI I Q1002
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$4 APPLICATION NUMBER: )3- 10 Yi' L -F�'_I
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CITY OF FEDERAL WAY APPLICATION NUMBER: _ _ - _ _ _ -
• BUILDING DEPT. }` — — H
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.
_ . ,, ' - 33( 51` �f in PROPERTY INFORMATION -- -
SITE ADDRESS: 2t!L — St" • ASSESSOR'S TAX/PARCEL It: -
0ZY O G
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): '/'1T
. - `_. . - a PROJECT INFORMATION
TYPE OF PROJECT(This application): Cl BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION
i l ELECTRICAL 0 ENGINEERING.FIRE PREVENTION SYSTEM
X PROJECT DESCRIPTION (Provide detailed description):
I NSi1W- C teMult,-E4S&i) tkbab vroc.7r 5 J P R S LD' SyS1L^M 'rO
2, PRE-PtPeD Wao4S. _
PROJECT NAME: .1 I M The O)
- - : - - -. ■ PEOPLE INFORMATION . _ - . -
PROPERTY OWNER: NAME:2.44. 0(Ar9Mh NON::
to The 20)4 Cute-
1
MAIIINCliadiei'STREC'T A001 Y,STATE.My_ , + M './_ .
CONTRACTOR' NAM ,�' ` c,ArnnkPN -QNi: -- 1
5614bC-R3cx� S 't'� (2) , ) „ D
MAlI tNG ADDRESS(T EET AOOPI:SS;C.'R'.ST TE,ZIF): CvENING PHONE:
..ZQ� Al S, .... ( ) - •
(lir OF FEDERAL WAY 8UylNE$$IICtNSE NUMBER: FA.):NUMBkIt.
j -9'9' . o (• 062 Oa (24 ) A,0-4301.
CnNrRACTOR•S REGISMRAIION tit MDER: E%PIRA010N DATE:
( reouleco _ 5 ( i) TIE ss z.4,OR.0 k / t). 'os
APPLICANT' NAME: 04rIiME FNONk;
��11 C71‘ totit (2D( )34D -4300
NG AOORfibS( CT S:G(TYA ST'7 •IP): EVENING P�ONE: -
34 (
RELATIONSHIP
'(•1►y0�1PROJECT: f/V•��\`�J�,/ cJ' / ��[ f/ FAX NUMaCR: !
❑ ARCHITECT 0 TENANT OTHER(DESCRIBE): t, "t. ( ) -
E-MAII ADORES:
CONTACT PERSON FOR THIS PROJECT: 0 PROPERTY OWNER %APPLICANT V CONTRACTOR I
- - - _ - - -` ■ DETAILED BUILDING INFORMATION . .- • . - _ - .
EXISTING USE: • _ EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: (11 9S010t /X
•
SPRINKLERED BUILDING? 0 YES Li NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES 0 NO
WATER SERVICE PROVIDER: • 0 LAKEHAVEN 0 HIGHLINC 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN rl 11IGHLINE 0 PRIVATC(SEPTIC)
04/29/2001 13:29 FAX 2336614129 CITY FEDERALWAY
7
;
"NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS: . ESTIMATED SELLING PRICE: $
■ PROJECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. ." TOTAL •
BASEMENT
FIRST /V
SECOND
THIRD
FOURTH ,
i
OTHER FLOORS(DESCRIBE)
DECK
/ ,
GARAGE
HOW MANY FLOORS?
TOTAL:
■`FIXTURES ,
Indicate number of each type of fixture
MECHANICAL
_ AIR HANDLING UN►(5) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEMS)
8BQ(S) " FAN(S) HOOD(S) WOOOSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESS, .(S) FURNACE(S)
DUCTS GAS PIPE OUTLET(S) HEAT SOURCE: 0 ELECTRIC 0 GAS
PLUMBING
•
BATHTUB(S) LAVATORY(S) URINALS) WATER HEATER(S)
DISHWASHERS) RAIN WATER SYS. VACUUM BREAKER(S) 0 ELECTRIC 0 GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTORS) 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 daim(induding 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 filed against the City of
Federal Way,but only where such claim arises out of the reliance of the city,including its officers and employees,upon the accuracy
of the information s lied to e ' as a art of this application.
/ , NAME/TITLE: IL u DATE:
•
❑ PROPERTY OWNER 0 APPLICANT lS CONTRACTOR
�y,
FOR OFFICE USE ONLY:
0 NEW 0 ADDITION 0 ALTERATION 0 REPAIR 0 TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION: BUILDING SHELL ONLY? 0 YES 0 NO . ' .
COMP PLAN DESIGNATION BASIC PLAN? 0 YES 0 NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? 0 YES 0 NO
PLATTED LOT? 0 YES 0 NO CHANGE OF USE? 0 YES 0 NO