01-104637A
DEC 0 4 200
uV f G1rY OF FEDERAL WAY
BUILDING DEPT.
0
CONSTRUCTION PERMIT APPLICATION
APPLICATION NUMBER: O 1 - I ,? -7 - E
APPLICATION NUMBER: - -
PPLICATION 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.
SITE ADDRESS: 311"00 Z ST LJE. 5T W, ASSESSOR'S TAX /PARCEL #: 0 _L _ ( D 1 1 sue? % _
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY): J 4 Z 3 Sb ' 0 to O
Fire inttso✓ 2�jb enn k0ex ,ia," ee-cQr :1
54Z
PROJECT INFORMATION
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING )(f FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): AOb MEk1 SPF-%--)KLJ0L 641ST:'' 2 To NE,)
(-t -luny _ ICE w1c) I: >(S'(Iu43 'C7?a1NV-1,E1Z 6'9TLAA JAt 6)k1SY1AJ (., r3ucLpwb
PROJECT
■ PEOPLE INFORMATION
PROPERTY OWNER:
CONTRACTOR:
NAME:
P AYTIME PHONE:
�U r �n W Cos ChA �r Ir\
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
U. V,:5c>C 25 ! ! I F e &A"V- -9- LL)Qyk. W \O, 014Z 09-'x.- -2,110
NAME: l
AIL(."ev- uNS -reu C, T i c>ni
DAYTIME PHONE:
( ZS 3 ) S-7 Z - 7 -, ZZ-
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
7$SS 7� Sr. K A,T
A 'N66 3
(' ) � iq -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
- �C{ � v_ _
- _ _
( ZS3 )'61z- _77-77
CONTRACTOR'S REGISTRATION NUMBER:
EXPIRATION DATE:
A�
(.E1�1_
Q
d
APPLICANT: NAME: DAYTIME PHONE:
�
_P
_ 64- Tadcat oN
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE:
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ' OTHER ( DESCRIBE): SAU -j4LW- Co+yi ( 2S3 ) &-7Z�
E -MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER - APRICANT )Q CONTRACTOR
EXISTING USE:
PROPOSED USE:
■ DETAILED BUILDING INFORMATION
EXISTING BUILDING ASSESSED /APPRAISED VALUATION $
PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? IYES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: A YES ❑ NO
fl
WATER SERVICE PROVIDER:
:1
Is
❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA o PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
* *NEW RESIDENTIAL CONSTRUCTION O� /NALY **
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: 9
■ PROJECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED S . FT.
TOTAL
BASEMENT
��v►3
AIR HANDLING UNIT(S)
FIRST
GAS LOG(S)
REFRIG. SYSTEMS)
BBQ(S)
SECOND
HOOD(S)
WOODSTOVE(S)
BOILER(S)
THIRD
RANGE(S)
MISC.( )
COMPRESSOR(S)
FOURTH
DUCT(S)
OTHER FLOORS (DESCRIBE)
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
DECK
BATHTUB(S)
GARAGE
HOW MANY FLOORS?
URINAL(S)
WATER HEATER(S)
DISHWASHERS)
TOTAL:
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
34 7 7-2
N 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 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 City of
Federal Way, but only where suyclaim ' es out of the reliance of the city, including its officers and employees, upon the accuracy
of the information s d to tart of t' plication.
NAME /TITLE: DE DATE: 144/01
❑ PROPERTY OWNER ❑ APPLICANT at CONTRACTOR
FIXTURES
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S)
EVAPORATIVE COOLER(S)
GAS LOG(S)
REFRIG. SYSTEMS)
BBQ(S)
FAN(S)
HOOD(S)
WOODSTOVE(S)
BOILER(S)
FIREPLACEINSERT(S)
RANGE(S)
MISC.( )
COMPRESSOR(S)
FURNACE(S)
DUCT(S)
GAS PIPE OUTLET(S)
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S)
LAVATORY(S)
URINAL(S)
WATER HEATER(S)
DISHWASHERS)
RAIN WATER SYS.
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
DRINKING FOUNTAINS)
SHOWER(S)
WASH MACHINE OUTLET
GAS PIPE OUTLET(S)
SINKS)
WATER CLOSET(S)
MISC. ( )
INTERCEPTORS)
SUMP(S)
N 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 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 City of
Federal Way, but only where suyclaim ' es out of the reliance of the city, including its officers and employees, upon the accuracy
of the information s d to tart of t' plication.
NAME /TITLE: DE DATE: 144/01
❑ PROPERTY OWNER ❑ APPLICANT at CONTRACTOR