03-105429 4. ilk NED
• PI'-5
DEC 1 5 2003 CONSTRUCTION PERMIT APPLICATION
CITY OF 0.131
APPLICATION NUMBER: Q a - �. [Z 5' 7%-
Federal Way E fii DING DEPD ALT, A� APPLICATION NUMBER: _ _ - _ _ _ _ _ _ -
APPLICATION NUMBER: -
**ThAiLinini IS required information—Please print(in ink)or type**
Please note: Electrk90)Firemcptioz Systems and Engineering permits may require a separate application.
1111 PROPERTY INFORMATION
1 #F—/�
SITE ADDRESS: - i .� . `S rai-aC, mGl l l ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTT•uh 0 • ECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
• PROJECT INFORMATION
TYPE OF PROJECT(This application): o BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
o ELECTRICAL o ENGINEERING.eT FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description):
re,loccoc S
PROJECT NAME: CD} l ,' Se-Ce l-C, f I lam,
■ PROJECT INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: NAME: DAYTIME PHONE:
Crown Fire_ Prc kth ) , Inc, (y2ST 981 - 71 /09
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
pp Box iZi ,3 ne) ,I► Cr��K 1oR 9goga ( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
(41%/ / - 869s
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) S.i e O \ E Y' (2 Z q l V /O y
APPLICANT: NAME: DAYTIME PHONE:
Sam-e c s Co nbec c ( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
o ARCHITECT o TENANT ❑ OTHER(DESCRIBE): ( )
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT „RodONTRACTOR 1 ihO/e (crOWl?fr. ( Th'
• PROJECT INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ 14 00
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES
WATER SERVICE PROVIDER: o LAKEHAVEN ❑ HIGHLINE ❑TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
* EWDENTIAL CONSTRUCTION ON* •
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE:
■ PROSECT 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 each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) - MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: a ELECTRIC a GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) 0 ELECTRIC ❑GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) 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 claim(induding costs,expenses,and attorneys'fees Incurred in the
investigation and defense of such daim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but only where sprch daim arises out of the reliance of the dty,induding Its officers and employees,upon the accuracy
of the information supplied to the city as a part of this application. ` �
NAME/TITLE: �/�',�� //,(2(,- � DATE: / r/44 c-`
❑ PROPERTY OWNER ❑APPLICANT a CONTRACTOR
,FOR.OFFICE,USE.ONLY,, I
:jj NEW, , „® ADDITION warty ALTEitATION - D REPAIR;' tl,TENANT IMPROVEMENT, -
I'CENSUS CODE AW . iWtt LOT SI E A. . . ,
''ZONING DESIGNATI( N te.. v is es BUILDING.SHELL ONLY? ,Q YES 1 N0 .:N
=COMP PLAN DESIGNATION =. i.,; b'..- R$IBASICeLANZiti YES , ❑,NO''A"
SECTIONa4. TOWNSHIPx' !I kANGE,V ;NEWADDRESS;REQUIRED?, aYES -[i NO
!'i PLATTED'LOT? �.❑YES ONO . k '.CHANGE OF USE?.Vis, q" ,'a YES 7t1'NO .-A-5-7',!--...-:,-,4-.
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www,citvoffederaiway.com