01-103862 •
1/"-. RECEIVED •NS I RUC I ION PERMIT APPLICATION
VV f3YL OCT 0 3 2001 APPLICATION NUMBER: C)1 - 1 '_ ° c} -
OCT Q 3 2301 APPLICATION NUMBER: _ — - _ — — _ — —
APPLICATION NUMBER: -
l'Y OF FEDERAL WAY — - — — -
**The following is Pe i I9 ation-Please print(in ink)or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
.PROPERTY INFORMATION � -
3sgo t w F�t•'.t as�Si�C v.) s,
SITE ADDRESS: ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
U.16y E2.1Q.0-i.c&,e. G 4„of i ca, tri e a octo ti 2T-t-2S — v-)G•te-2 NAGA,S eq. T-640 riot.o c�,. C C-•.•rc-vL
V.1Eyc ulACAltemt. ) Sr
r: c Y.: : . �_ _i,. p 'z .. ,�,..., ' I•f PROTECT INFORMATION . =
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING% FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): J213N/tc& U L 3oO IAfJAn/lnr �) Fx i S
I ti 11-00 S _n.. - • Lac.G- A.L.L Cl.y.�..,<<.a. 5. s rG.-.
00 ` � w6p v'1 GT" S c .tet.
PROJECT NAME: - 1a0
.. .,<.-.,.__ _> �..� ;.-�. -, � •PEOPLE INFORMATI N .. - _ F � -
PROPERTY OWNER: NAME: DAYTIME PHONE:
VJENE-2144EUSG-1. (Z55 )(ivy - \3Sf1(
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
334c.A'3t,.1Cy6-12a SC-R. UJA1 5..j C617c-CA• LdP",‘, wti ' 'C
CONTRACTOR: NAME: DAYTIME PHONE:
Cues Wto rt-c-n a^-) (as, ) 731 —7-46°
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
t Z20 3 Tr- ST NJ u-) 5UATG- tote c.Jju & I not ( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
L s. 8 - Lts ( ) -
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(ropy of card required) G 1 N NE ? L 3 L E t 2 / 1 / o
APPLICANT: NAM DAYTIME PHONE:
yJC ELA aQ E e e- (253) '131-2.2A-16
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
‘22-( 6 3-i1'' a. A..)w -#k fob , Aaaemva, Qcismi ( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT 2OTHER(DESCRIBE):` _„cke_cA- (2.55)-4 3-4 - 2301
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER A APPLICANT ❑ CONTRACTOR
1.:DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ iipmmonsoo ./-/(J
SPRINKLERED BUILDING? YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:%YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
• � f
-,,,p *:%*.4.,.,,O,JAAt'''' '.'$'?4111614410
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: • ESTIMATED SELLING PRICE: $
':■ PRO]ECTFLOOR AREAS
FLOOR EXISTING SQ.FT, PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
URES .
:'''":1.;-:,..'..111 �:�FIXT -.. .,
Indicate number of each type of fixture
-
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) • GAS LOG(S) REFRIG.SYSTEM(S)
FAN(S) HOOD(S) WOODSTOVE(S)
RANGE(S) MISC.(
BBQ(S )
BOILER(S) FIREPLACEINSERT(S)FURNACE(S)
COMPRESSOR(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S)
LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHERS) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINKS) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
. 7 .7:DISCLAIMER/SIGNATURE BLOCK
I certify under penaltyof perjury that the information furnished by mte 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 daim),which may be made by any person,including the undersigned,and filed against the Cityof
Federal Way,but only where such claim arises out of the reliance of the city,induding its officers and employees,upon the accuracy
of the information sup lied to the cl as a part of this application. G?
NAME/TITLE: /AI 'E.tz lZ- DATE: ` 'Z'5-�I
❑ PROPERTY OWNER ❑ APPLICANT 'CONTRACTOR
'"FORDFFICE1VSEVNLY,:iiR
.. . ... ❑ ALTERATION ❑;REPAIR El TENANT IMPROVEMENT.-
NE1fVm1C ADDITION
''''" :,'-.':i''si',,''„.'..!,,,..:....:.::'
':,:.;
:'
CENSUS CODE LOTSIZE
ZONING DE ENATION ,„ BUILDING SHELL ONLY? >El YES _❑ NO
COMP PLAN DESIGNATION � BASIC°P.LAN' ❑YES ❑NO'
SECTION, TOWNSHIP RANGE NEW ADDRESS REQUIRED? .❑ YES ❑ NO,
PLATTED LOT?.: ❑YES, ❑ NO CHANGE OF.USE?, ❑YES ❑ NQ_
COMMUNITY DEVELOPMENT SERVICES-33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129