03-104970 ( r
`�'°' ° CONST
� .� RUC I 1 N PERMIT APPLII°Q-5CATION
LIGATION
VV Fr).- 1- APPLICATION NUMBER: DS- _I jb_q1_7-o-
QA SIL T?E116vIG(� APPLICATION NUMBER: -
D'\ APPLICATION 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.
• . -. 1.�:PROPERTY 7" ORMATION
S L: DNSUBJE O RTY(ATTACHSEPARAT i.; jiflHï
ION IF LEN
;;'.. .._ : _.:: . i '', r ., : .11 'PROJECT INFORMATION-::; , . .-.
TYPE OF PROJECT(This application): "-gi BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL 0 ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): CONSTRUC_I A NISI 3 BED2oor., 3ak"r{-k 4jiN6(-e
L., 2E i 6 \nJ To A s►_
.rlv1M
PROJECT NAME: Z. ; —1501r.1, ri
[,i
Of�I ( LL
'ilAAIIIIIIp
7-7.411L...i irsti& i..
.:. .. • . . , . . .::►.t PEOPLE INFORMATION - 7 . :' .
PROPERTY OWNER: NAME: DAYTIME PHONE:
c..iNNEVtEE.2. \ o/"1E5-, 114C. (Z06 )Z' 8 -247 I
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
(o510SooTHCEr.rr e. 8L,vo, " )IC AL4.k, \iii, 98142:a
CONTRACTOR: NAME:pi DAYTIME PHONE:
bCAMAE.Vee-AAC l MC. ( o)248 -2417)
MAILING ADDRESS(STREET ADDRESS;CITY,STA ZIP): EVENING PHONE:
(0510 Sour kyTee_ 1 . �vgwtc,A, A. 9818PS (Z )248 -2"171
CITY Of FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
L C - 4197_10_34,24-00- ELL._ (244)242 - 424:41
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) SCI-Idle . 2.145 ea. - - - 03 /01 / 03
APPLICANT: NAME: DAYTIME PHONE:
gN€A, (tot)246 -2.47 i
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
(o610 Sou 1.14 cE i TE 2. &vo. !UKW ii Jk4 1 S9 (2 .1.p )242, -4?-09
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT A OTHER(DESCRIBE):&05. ,,,3 , (Z0(0 )24Z - 42o9
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER APPLICANT. ❑ CONTRACTOR
A DETAILED BUILDING INFORMATION •
EXISTING USE: hI/A EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
OPOSED USE: S 4 a PROPOSED VALUATION FOR IMPROVEMENTS: $ 2C O00
SPRINKLERED BUILDING? ❑ YES 'Eli NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES---N11 NO
WATER SERVICE PROVIDER: "'{J LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: 11 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
311 t/ 31
**NEW RESIDENTIAL CONSTRUCTIO•LY** •
NUMBER OF BEDROOMS: 3 ESTIMATED SELLING PRICE: $
. iS PROSECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST 348 C 3+8
SECOND
THIRD 42_ 111
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE62.1 to2.
HOWWMANY FLOORS? I
TOTAL: 293 J Z9 3 /
•. —�..c+yw:f.s�w•;«:�:;.%;.+eaa= ��..a�:.;,.;.•,sNc2}�iv�^i:4r+sECxxruiri7atiii ll'� JjMi:+ew!vii�it-wrr:.ew•tw+wsi�7 i+�w .:le:rx:w.+ri�agrrwwv:+.eeiah�av w�kfi+e:..
Indicate number of each type of fixture
MECHANICAL
I AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) •Lj FAN(S) I HOOD(S) WOODSTOVE(S)
BOILER(S) Z FIREPLACE INSERT(S) I RANGE(S) MISC.( )
COMPRESSOR(S) ) FURNACE(S)
DUCT(S) 4 GAS PIPE OUTLETS) HEAT SOURCE: ❑ ELECTRIC GAS /
PLUMBING
Z BATHTUB(S) . 1{ LAVATORY(S) URINAL(S) ... I WATER HEATER(S)
I DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC A`'`® GAS
DRINKING FOUNTAIN(S) • SHOWER(S) �. E` WASH'MACHINE OUTLET
). GAS PIPE OUTLET(S) L SINK(S) . WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
' •-;-7 .2' :4'DISCLAIMER%SIGNATURE BLOCK •
. • '• I certify under-penalty of perjury that the infoti>iation 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 Bairn(inducting 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 claim arises out of the reliance of-the city,including its officers and employees,upon the accuracy
of the information supplied to th as a part of this application.
NAME/TITLE: b 11 E: �/)/L
'PROPERTY OWNER. ❑ APPLICANT , CONTRACTOR - -
4.42:FOR OFFICE USEONLY....
EW., 0,;ADD]TION SLI ALTERATION 1REPAIR oTENAtNTTIMPRO.VEMENT
SC
O ING DESIGNATION '"--` r UIIAING EL +D LX D YES'=40 NO
COMBASIC PLAN?ma CYI S21• `i10 ,. _. r..'
SECTION TOWNS IP RANGE 3 14 ADDRESS REQUIRED?- ❑4 YES4 t�� t 0 °
Lk7TED,L to 0 i .•
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000-FAX:253-661-4129
www.citY4ffederalway.com