04-102037 f • PP
�� 'ECM/ED CONSTRUC 1 ION PERMIT APPLICATION
r CITY OF �/. APPLICATION NUMBER: ()el- LO..2..c73q- VO
Federal Way MAY 2 12004 APPLICATION NUMBER: -
(APPLICATION NUMBER: - -
QITY OF.FEDERA L
"The follo ation—Please print(in ink)or type** J
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
- El PROPERTY INFORMATION
SITE ADDRESS 11•o -J'` P000d SLD ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
- ■ PROJECT INFORMATION
TYPE OF PROJECT(This application): o BUILDING o PLUMBING ��❑ MECHANICAL o DEMOLITION
o ELECTRICAL 0 ENGINEERII FIRE PREVENTION SYSTEM
PROJECT DESCRIP •N(Provide detailed description)• 4 L( 5 a W
A )) %U0 CIC
Vim' 4 \.(z.... ' tri ! • a ' Y) (-6, (:,_, ' 4- Mr, .
Ln )riG c O -A hG Nu.] id ( 0 ,
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PROJECT NAME. -�0-C f • Vie '--�
■ PEOPLE INFORMATION-
PROPERTY OWNER: E:' DAYTIME PHONE•
)/ahObban D e\opc%n--i- f125 vay-.s oo
MAILING ADDRESS(STREET ADDRESS*CITY,STATE,ZIp. �l
1233 3 � �
Ce 11 loth �'�r)) •
/ 3
CONTRACTOR: N• E: 4-in
' i DAYTIME PHONE:
c �A.mL ; p ) - i? 50,
MAILING DRESS( ET°DRESS;DTII',STATE.ZIP)* 1C` Q , �/ L rEVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER: t
1 � -f70000 00 L ) �I
CONTRACTOR'S REGISTRATION NUMBER:
I EXPIRATION DATE:
(ropy of card required) m 1Jh 5 13 6 07— i 1 ) / / 61_
APPLICANT: NAE, ,..L1 '
1 I ,/^ S LAte DAYTIME PHONE: -I
MAILING ADDRESS(STREET ADDRE S CITY, ATE.ZIP): �� TNG PHONE-
1 110! 1 pct S ( )
' RELATIONSHIP TO PROD i FAX
0 ARCHITECT 0 TENANT o OTHER(DESCRIBE): [V•.-,b�M
Z-v 9 i:: t.
E-MAIL ADDRESS: I
I
CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER o APPLICACONTRACTOR 1
-■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ /3 0 a V
SPRINKLERED BUILDING? o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES 0 NO
WATER SERVICE PROVIDER: o LAKEHAVEN o HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ON.
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT 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: ❑ 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.( )
INTERCEPTORS) 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(including costs,expenses,and attorneys'fees Incurred in the
investigation and defense of such claim),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 city,induding its officers and employees,upon the accuracy
of the information supplied to the city as a part of this application.
NAME/TITLE: 1 Or 1 :iI)(JJ7 CI DATE: (-- -/CD-.' /01-
❑ PROPERTY OWNER ❑APPLICANT D'CONTRACTOR
_.FOR•OFFICE.USE ONLY:.:I
® ADDTTION s .❑ALTERATION �OiREPAIR�:,r 0„TENANT IMPROVEMENT,-- �„
.,,��
'CENSUS`CODE € _ ` , :3 .LOT SIZE ? '
ZONINGrDESIGNATION _ BUILDING.SHELL'ONLY? o YES t1=:13.13 NO � ''
COMP PLAN ESIGNATIONf , p:_,- BASIC PLAN?, :o.YES ,' ❑ NO
SECTION e.TOWNSHIP GRANGE Nt.OVTP.:;NEW ADDRESSREQUIRED? ❑'YES [i NO.;m
'PLATTED"_LOT? =❑YES=_ a NO K % fa, f CHANGE OF USE? ,4, ❑YES 'a'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