03-102285 (2)0'T'/11/2002 14:06 FAX 25366141 CITY FEDERALWAY �) 10002
r JUN 0 4 2003
CONSTRUCTION PERMIT APPL.ICATION
dTY OF FEDERAL WAY
PPLICATION NUMBER: 1 D %
BUILDING DE?T, PPLICATION NUMBER: _ _��
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. 0 -S-r 0
Y SITE ADDRESS: _ 930 SW 314th Ptaee, Pedeliat Way ASSESSOR'S TAX/PARCEL #:
LEGAL DESCRIPTION OF SUBJGCT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): 34 BUILDING ❑ PLUM13ING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL LD ENGINEERING(-) FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): Remove exi,6t ng eedgA �s hake !coa nand
teptace wic h Inteitock Atu.minum Roo4ing.
PROJECT NAME:
PROPERTY OWNER:
1'7Kels s eA
At1lNG nDDRi•SS [STREC'f apDRESS; UIl', 57,,M ZIP):
930 SOU 314th Ptaee, PedeAa2 Way, , WA 99023
O NT RACTO R: NAriE:
I►'te Lock Indu6ttiez, Inc.
RZL:NG A66R ($I REST AD RCb - CrrY. STAY►, 2IP3: —
7505 HaAdeun Rd, Suite 400, EveAett WA 98203
Ci rY Of rCOEF L WAY HUSMESS I ICE N4E NUMUA:
20-00-103408-00-BL _
I-o4ii Curs REGISTRa I ION NUMOCR:
Ij (to"«alrarr41 INTERII020LC
A PLICANT: NAME:
CONTRACTOR
r-IaILING ADDRESS (Srk-,.E ADORESS; CITY. srATr, Zlr).
KtLA'Q0NS1111' TO PR0)[CI': —
❑ ARCHITECT ❑ TENANT ❑ OTHER ( DESCRIBE):
CIGNTACT PERSON FOR THIS PRO)ECT: ❑ PROPERTY OWNER ❑ APPLICANT RJ CONTRACTOR
(253 ) 941-9302
DAYTIME PI IONS:
( 425 ) 438=8585
NENING 0110a (-
( 800 ) 772-F233
rAX NUMBER:
( 425 ) 438-8577
EXPikkAlIpN DATE:
0.1 / P7 12005
L+aY17ME PHONE:
evrWIN[i HONE: —
rax NOMCEFt
( )
EMAIL ADORF$$:
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS_ $` 22, 687. 00
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
❑ tAKEHAVEN ❑ HIGHLINE
❑ LAKEHAVEN L] HIGHLINF.
❑ TACOMA ❑ PR?VATE (WELL)
0 PR.IVATE(SEPTIC)
V./11/2002 14:06 FAX 2536614- CITY FEDERALWAY
Z003
s.NeW RESIDENTIAL CONSTRUCTION ONLY"
NUMHER OF BrUROOMS: - EST MAYED SELLING PRICE:
AIR HANDLING UNIT(S)
Bi;Q(S)
BOILERS)
CO M P RESSO R(S)
DUCT(S)
aATHTU B(S)
orstd WASHER(S)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTOR(S)
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLERS) GAS LOG(S) REFRIG. SYSTEM(S)
FAN(S) HOOD(S) WOODSTOVE(S)
FIREPLACE INSERT(S) RANGE(S) MISC. f
FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
LAVATORY(S) URINAL(S) WATER HEATER(S)
RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
SHOWER(S) WASH MACHINE OUTLET
SINK(S) WATER CLOSEr(S) MISC. (��_
SUMP(S)
I certify under penalty of perjury that the infoimation 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 incurred in the
investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the Gty of
Federal Way, but only where such daim arises out of the reliance of the city, including its officers and employees, upon the accuracy
of the information supplied to the city as a part of this application.
NAME/TITLE: 'l,r� ull_ Y V L L .� DATE:
❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES - 33530 FIRST WAY SOUTH - PO BOX 9718 - F£DCRAL WAY, WA 98063A718 • 253-GGI-4000 • FAX: 253-G61-9129
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