00-105959 CONSUCTION PERMIT APPLICATIC
�7E L_ APPLICATI N NUMBER: Q (2 - 1_ Q _-C. `/ i- _
- ED APPLICATION NUMBER: _ _ - _ _ _
6PPLICATION NUMBER: — _ - — _ _ _
DEC 1 1
2000 **The following is required information-Please print(in ink)or type**
,,,, . ,,, Pig4wKt r lectrical,Fire Prevention Systems and Engineering permits may require a separate application.
8 6 to r .
rig
- 0 PROPERTY INFORMATION
SITE ADDRESS: /'Q 1 7 .A - .4_Q. ASSESSOR'S TAX/PARCEL#: •_ ),7_. o 0 0 -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): AI-
.
; r - 'tl: PR07ECT INFORMATION
I
TYPE OF PROJECT(This application): U BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION
• 0 ELECTRICAL 0 ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description):
PROJECT NAME: riiG . a
_ _ 0::'PEOPLE INFORMATION
PROPERTYOWNER: NAME: DAYTIME PHONE:
V. I A u..% A ii• ail Lie At; I _.. 11111,'01 a. ) r v'`�
MAI NG ADDRESS(STREET ,OT. ;a ,STA : ZIP): All
CONTRACTOR: NAME: Y � 1 � DAYTIME PHONE:
47 �] _ , ejnHA�l4DVo)
—*N7
MAILING ADDRESS(STREET ADDRESS; STATE,IIP): EVENING PHONE:
YtY L ` ,' 1 ,-4
)
OF ABUSSNESS UCEN
FAX NUMBER:
- - ( ) -
CONTRACTORS REGISTRATION NUMBER: EXPIRATION DATE:
47g 1-
17 Z 1. - / /
APPLICANT: NAME: DAYTIME PHONE:
'7F--,g, e*?dr-47 ( , -
MAILING ADDRESS(STREET ADO ATE,ZIP): EVENING PHONE:
(
RELATIONSHIP TO PROJECT: FAX NUMBER:
A ARCHITECT 0 TENANT 0 OTHER(DESCRIBE): ( ) -
- E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: $PROPERTY OWNER 0 APPLICANT 0 CONTRACTOR
■ DETAILED BUILDING INFORMATION
EXISTING USE: t74 r2F-111141-... EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ '
PROPOSED USE: AtT Tt PROPOSED VALUATION FOR IMPROVEMENTS: $ hoG1
SPRINKLERED BUILDING? 0 YES ® NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES U
WATER SERVICE PROVIDER: S LAKEHAVEN 0 HIGHLINE ❑TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: 5 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
•
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROO� ESTIMATED SE' 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 = • = - =i
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEMS'
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: 0 ELECTRIC 0 GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S'
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) 0 ELECTRIC 0 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,an
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 th
Investigation and defense of such daim),which may be made by any person,including the undersigned,and filed against the(Sty o
Federal Way,but only where such daim arises out of the reliance of the city,including its officers and employees,upon the accura
of the information supplied to the city as a part of this application.
NAME/TITLE: 1�/5.,.., 4+ h 4)qDATE: 1 4/l G
ill PROPERTY OWNER ❑ AP LICANT CONTRACTOR
ROFFICE 1SE ONL(f r� , =:a
Ew E DOITiO1V VIM!aUTERATIONS EP��� Ra M I1AH I PROVEMENT'
NINE ESIGPCA`TION { -if e'er UxL IN LL LFft I . Q :
N P ,lAN DESIGNATIOK a �je� BASZC f1N7 _ $1O �'
EGTIQN __3`TOWNStIIP= �, fiANGE � l O t SS REQ11IEl.ED 5 .NO :,-
AUED O7?. (FSS t NQ 01AI eiikl SE'►� ...R :. CS.r, ,-No n.atst.
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718.253661-4000•FAX:2536614129