Loading...
04-104386 CONSTRUCTI N PE MIT//APPLI APPLICATION / 11 •° :44111114444#kre CITY OF ill RECEIVED APPLICATION NUMBER: - 151 - s1 Federal OCT 2 6 2004 APPLICATION NUMBER: - ���� pp APPLICATION NUMBER: - **The ECNc�''I rind nfo mation-Please print(in ink)or type** Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application. 1-40\-St- • PROPERTY INFORMATION Z SITE ADDRESS I-t0` T ?CC . SV`-' 62 TAX/PARCEL#:(59- t C� 0 © - ©J2,v LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): • PROJECT INFORMATION TYPE OF PROJECT(This application): 0 BUILDING o PLUMBING o MECHANICAL ❑ DEMOLITION o ELECTRICAL o ENGINEERIIVt-n-FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description): PDO t'n ct. d Celocali 0 NIL... Ir�d5 A-ce CtCC'c '>\oc(it -k iNo,rv-- l(3') i1 SLI ._ PROJECT NAME:Ta)t2UXu 2 -4cM ( I. 1,' • PROJECT INFORMATION PROPERTY OWNER: ME: ^ ,, , DAYTIME PHONE: t 1 10\ebin OQAK..-'ErilOA-, '0-0 - ,S ( ) MAILING ADDRESS(STREET AD ESS;CITY ATE,IIP): Z3 C .el etCf D't-1 I CONTRACTOR: DAYTIME PHONE: da-1 3 G ADDRESS(STREET DRE CITY, ZIP): EVENING-__ ---/cic. GiD 9s2 PHONE: CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER: l j -g 7a)003 CO_3L .dam 9-,,"1,/ -o ) CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:�J /��/ (copy of card required) 1 Z' /3/ / v�' i APPLICANT: N DAYTIME PHONE: MAILING ADDRESS FE f ADDRESS;CTfY, Z EVENING PHONE: - RELATIONSHIP TO PROJJEECTT: Cc FAX NUMBER: �,/ ❑ ARCHITECT ❑TENANT tea--OTHER(DESCRIBE): -CO--- j) /cep -3.5.0 E-MAIL ADDRESS: CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER o APPLICANT CONTRACTOR • PROJECT INFORMATION EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ PROPOSED USE: ran 102-Pc)�. PROPOSED VALUATION FOR IMPROVEMENTS: $ , 10.3 SPRINKLERED BUILDING? o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:o YES ❑ NO WATER SERVICE PROVIDER: ❑ LAKEHAVEN o HIGHLINE o TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER: o LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) r**NEW RESIDENTIAL CONSTRUCTION ONL 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 UNITS) 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 o GAS PLUMBING BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S) DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) o ELECTRIC o 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(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 such claim arises out of the reliance of the city,including its officers and employees,upon the accuracy of the information supplied to the city asa part of this application. NAME/TITLE: Lo 1 atficcv--) DATE: W1C7l ❑ PROPERTY OWNER ❑ APPLICANT "'}CONTRACTOR 666 FOR OFFICE USE ONLY: o NEW o ADDITION o ALTERATION ❑ REPAIR o TENANT IMPROVEMENT CENSUS CODE: LOT SIZE: ZONING DESIGNATION: BUILDING SHELL ONLY? ❑YES o NO COMP PLAN DESIGNATION BASIC PLAN? o YES ❑ NO SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? o YES o NO PLATTED LOT? o YES o NO CHANGE OF USE? ❑YES ❑ NO COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129 www.cityoffederalway.com