04-103998C1071ki1717]'S'AEYFlAPJ�lY1'" xY(�
:cry lot 33530 FIRM WAY SOfI17i • P 8t7�t 97Id
FIEDML Fec�eraX %May F3FCF-1VA,•__1RMIT APPLICATIOI ws � ", t
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of5m use OuIY - J' _ ^ �-y ('S T0:
The falloupinar Its rrnatlan - on Gera lete{l�J ILcadort will not be Please nt n ar
PROPERTYO-MATI•
SITE ADDRESS: Z`l I l is c.� ��� t4W 1rS.,4 K72� L&� 01, POMUITEIAPT #
ASSESSOR'S TAR/PARCEL #: f5 Q - Z L O SQUARE FOOTAGE OF LOT: �� 6 �� f �S, A�7
F.
LEGAL DESCRIPTION (e.g.: Anne Estates, Lot 1)
(Attach separate page for l ngmy legal desaiption)
TYPE OF PERMIT (This application(: BUILDING PLUM SING MECHANICAL 11; DEMOLITION
;(4 11 TRiCAL ❑ GIHEERD7 ❑ F PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onluh Coj,4%)F ' lr= 1<
f„_. ..
PROJECT NAME (Name of Business/Owner Last Name):
PROPERTY
OWNER
CONTRACTOR
LENDER
prp-v dv.Er>••,00O)
APPLICANT: NAME: CGMPAHY - OFFICE PHONE:
MAILING ADURESs WFREL-r ADDRESS): Cny. STATE.23P rEVENING PHONE: _
RELATIONSHIP TO PRO,IECr: - FAX MB EFt
❑ Architect ❑ Tenant ❑ Other (Desaiber _
CONTACT PERSON FOR THIS PROJECT; ❑ Property Owner ❑ Contractor V Applicant r -MAIL wlaREss.
DETAILED BUILDING•- •
EXISTING USE: 1�i. _c]=M c-Ib1-r i . PROPOSED USM
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORN:
SPRINKLERED BUILDING? ❑ YES jQ NO FIRE'SUPPRESSION SYSTEM PROPOSED/REQUIRED?: ❑ YES 0( NO
WATER SERVICE PROVIDER! ❑ LAEEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAsrFFrAVEN 0 HIGID,INE ❑ PRIVATE (SEPTICI
AREA
PRt.. .iSED_ Q. FTC TOTAL
i
l
t
FIRST
51-COND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK tCOVERED?f
GARAGE/CARPORT
HOW MANY FLOORS?
.NEW HOMES ONLY" NUMBER OF BEDROOMS
TOTAL EXISTING TOTAL PROPOSED I TOTAL MS -MI, AND PROPOSED
ESTIMATED SELLING PRICE $ 1
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
NECHA NTCAL 4�
Value of Mechanical Work d
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG. SYSTEMS
HOODS Icorc;,I1 WOODSTOVES
Io��
FANS
BOI
LERS FIREPLACE INSERTS -• RANGES MISC (Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS .
PLUMBING
BATHTUBS (.rTub/Sho C..b.J SHOWERS �_ WATER CLOSETS (Describe )
DISHWASHERS SINKS DRINKING FOUNTAINS
MISC
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
.,m _ I_— VACUUM BREAKERS ELECTRIC WATER HEATERS
!_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 W as any c im rncI ding costs, expenses, and attorneys' fees incurred in the investigation and defense of
such claim), which may be made y pery includi the undersigned, and filed aga(resE the City of Federal Way, but only where such claim
arises out of the reliance of th , neludin is ofc and employees, accuracy of the information supplied to the city as a part of
this application �
.. DATE
l � 30 ^ �
NAME/TITLE (Clete)
,gnat i
RELATIONSHIP PLC IECT `❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other-
0
NEW } : o ADDITION a ALTERATION
BIIIY.DIHG SHELL ONLY? o YES a NO
ZONING DESIGNATION •
NEW ADDRESS iiWUIRED? a YES 'a Na
PLATTED LOT? a YES q X0
o REPAIR t}.T£HAN T IMPROVEMENT
BASIC -PLAN[?
OYES
NO
CIiANGE.OF-US E? -
aYES
o.NO-
UP/SEPA/SU?:
a YES
a NO
DEMO PERMLT REQUIRED?
a YES
a NO
f
a
t
Bulletin I1100 — March 30, 2004 � Page 2 of 4
LAI{andouts — ReviseMermit Application
Cd
C
4: 1
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CRESTVIEW WEST a Q
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27912 PACIFIC HWY S Phone: 839-8222
0 50 100 Feet Q
Type: Apartments Units: 222
23
Kroll Page: 366 Patrol District: FW3 Tile: 5 Scale: 1 inch =109 feet
_