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04-100128 1` T .._ / Co� ,r NSTRUCT PERMIT APPLICATION CITY OF 1 ��✓ ).'' £... ' Federal Way APPLICATION NUMBERAPPLICATION : �� JAN 1 5 7.004 kPPLICATION NUMBER: - - **The folloVrifig(idiititOrW n—Please print(in ink)or type** Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application. I ii :I PROPERTY INFORMATION: . _ SITE ADDRESS: 3(65-3 rucrf c vituki S - Cafe C ASSESSOR'S TAX/PARCEL #: - LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): 6133it 0'5 - S'ui't C ( Pavilion C¢n-6ee ■ PROJECT INFORMATION TYPE OF PROJECT(This application): o BUILDING o PLUMBING 0 MECHANICAL 0 DEMOLITION (1' ELECTRICAL a ENGINEERING ,QQFIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description): LOW 'V CTGE F=IRE i11l,ilicl T..T. wit ea 'CAR/ PROJECT NAME: of GG((. HOO S PEOPLE INFORMATION;. PROPERTY OWNER: NAME: ; DAYTIME PHONE 1W5 Li .Lvwe5t �-4-5 ( ) - MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): CONTRACTOR: I NAME: DAYTIME PHONE: Q Pi QrJ, ►�C. n06 ) ` efo - 1�7tJ 3 MAILING ADDRESS(STREET ADDRESS;CITY,STATE.ZIP): I. EVENING PHONE: 120(15 3154 five LE sacita(€,uJA g '(25 I ( 2o6 ) No - 5-73 CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER: © 0 - t a e y g w - 6 0 el. ( -z06 ) (04 - 2o57 CONTRACTOR'S REGISTRATION NUMBER: I EXPIRATION DATE: (copy of card required) F R E- !" / ' 0 2 ' i'4 L i di / 07 / 0 y APPLICANT: ( NAME: DAYTIME PHONE: Ree PRo-rrat 1, i 0C . ! (z06) KO - 5743 MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENINGPHONE: 1 Z0(0 1154 ate OF, ,`vtal q /Rid 9812 c I (706 ) Y*0 - 5.763 RELATIONSHIP TO PROJECT: FAX NUMBER: 0 ARCHITECT 0 TENANT kOTHER( DESCRIBE): CON Q2h^TOr. (20C. ) y(7j - g°5) E-MAIL ADDRESS: CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER (X APPLICANT g CONTRACTOR 2--■ DETAILED BUILDING INFORMATION _ EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ PROPOSED USE: 6 PROPOSED VALUATION FOR IMPROVEMENTS: $ II 45 5 SPRINKLERED BUILDING? KYES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: YES to NO WATER SERVICE PROVIDER: a LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC) **NEW RESIDENTIAL CONSTRUCTION • .** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ ■ PRO3ECT 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: o ELECTRIC ❑ GAS PLUMBING BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S) DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ 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 daim(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 such 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: lit/44k. Orki to V1DATE: 170/01/ ❑ PROPERTY OWNER iNAPPLICANT di CONTRACTOR _.FOR:OFFICE.USE,ON LY t7 1lEW p ADD7.� rnuREPAIR �;Ij'TENANT IMPROVEMENTS , 3'CENSUS:CODE s ''T #? ,w n f r ar' ? ZONING DESIGNATION BUILDINGSHELL ONLY? 'O COMP PLAN DESIGNATION ^ BASIC PLAN? o YES =❑ NO," . , SECTION. TOWNSHIP-x ', RANGE ,.NEW ADDRESS REQUIRED? ❑YES ❑ NO ^PLATTED.LOT? ❑YES ; ❑NO: .°CHANGE OF USE?=` �n k - -• nYES °*-ci NO ' COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129 www.dtvoffederalway.com