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01-104736 EG.:I Er CONS I RIA ION PERM I APPLICATION APPLICATION NUMBER: 1 - _ '13.67 - uV Ffi7. DEC 13 2001APPLICATION NUMBER _ n .-- _ APPLCATiON..'NllMBER' _' _$ _ ' liii.( OF F i")ZRaii_WAY **TFetfili eN0 ei quired information–Please print(in ink)or type** Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application. ri. °.. 1'd:;:PROPERTY INFORMATION SITE ADDRESS: 33�D ,�ST wo.y spv� ASSESSOR'S TAX/PARCEL#: 3 6 ...s- aq. - 0 Q 1 (� LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): 1i-=PR07ECT.INFORMATION TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERINGN FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description): le Ey.,S,Ti Rc� 6�/SL t-_ o /7UCJ 20 Ne. CiriX,)et'S tt� Nat../ Ill fkZ iilj; J PROJECT NAME: V 6` 1 ,r\ ;‘,\_ 11660 r\ 1\11 _r�1 ; PBOPLEINFORMATION. < <n .�, _.- s PROPERTY OWNER: NAME: DAYTIME PHONE: V ZN RFSS( ET A0�ctiS ( ?P ) 3?( b`I3 ) CONTRACTOR: NAME: I DAYTIME PHONE: !-\.s . — — ( ( -- M LING ADD (STREET ADDRESS-CITY,STATE,ZIP): t 0 ` EVENING PHONE: ' att, oiteg_e .tel ,.., slot (gc6 ) `H - 3 7 3___ CITY Or rEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER: LCL — 104i - © o ( ) Y CONTRACTOR'S REGISTRATION NUMBER: }� �{ /� }[ EXPIRATION DATESl �� (copy of card required1-) E S , S� 1 7 / ® f /20c.2– APPLICANT: OZAPPLICANT: NAME: DAYTIME PHONE: FSec;n c) - S�/STc,• s Lnc_. (Zo6 ) 763 Y.?7/ MAILING ADO (STREET ADDRESS; ,STATE,ZIP): 3�1 S. (,lnve malt' /. b-tEVENING PHONE:o 6__Cp1/4ttktt? BLoe (Zo6 ) `t'il - 1373 ' LATIONSHIP TO PROJECT: FAX NUMBER: ❑ ARCHITECT ❑ TENANT -OTHER(DESCRIBE): SVIa•(.onTCccl?,.0 ( Zoo ) 763 - I20 E-MAIL ADDRESS: CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER (APPLICANT ❑ CONTRACTOR LI!y Q c:ze�owt'd Itc,Con- .DETAILED BUILDING INFORMATION „-;ii;:.y ,_; EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ PROPOSED USE: ROPOSED VALUATION FOR IMPROVEMENTS: $ J t-TOO. SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHIINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) r � **NEW RESIDENTIAL CONSTRUCTION ON * NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ PROSECT FLOOR AREAS.. FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL BASEMENT FIRST SECOND THIRD FOURTH OTHER FLOORS(DESCRIBE) DECK GARAGE HOW MANY FLOORS? TOTAL: a `: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) 1 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.( ) INTERCEPTOR(S) SU P(S) ` `-gl 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 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. I. NAME/TITLE: a. /, �i --- f Ge5.\G)C41-- DATE: I Zs 13-01 ❑ PROPERTY •WNER 1-APPLICANT CI l . - 1 FOR OFFICE USE ONLY ❑ NEW ...-=';', ❑ADDITION ❑ ALTERATION ❑:REPAIR - ' ❑ TENANT IMPROVEMENT CENSUS CODE: " LOT SIZE: ZONING DESIGNATION `< BUILDING;SHELL ONLY? ❑ YES ❑'NO COMP PLAN DESIGNATION BASIC PLAN? ` .❑ YES ❑ NO` SECTION _: - TOWNSHIP RANGE NEW ADDRESS REQUIRED? El 0.NO PLATTEDLOT? =❑:YES ❑ 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 1