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05-103271 • L 11-1 k CITY OF G CONSTRUC•N PERMIT APPLICATION VED ` COMMUNITY RECEIVED DEPAPIUcICATION NUMBER: Qom- [0.3 21 - c"o APPLICATION NUMBER:, _ 0 5 — 103 2.7 1JUL 0 7 2005 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. ■ PROPERTY INFORMATION �y SITE ADDRESS: DOL --�. '5D04" -C-r t ASSESSOR'S TAX/PARCEL#:Q� 42-( 0 (.4 LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): ■ PROJECT INFORMATION TYPE OF PROJECT(This application): o BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING p9FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description): kA.t Rt 2 A c _ .c-c.F1)4,(5 5 5' 1 PROJECT NAME: CAcA &r t • PEOPLE INFORMATION PROPERTY OWNER: NAME: DAYTIME PHONE: ) MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): CONTRACTOR: NA DAYTIME PHONE: (STREET o h c D Uc4 (2cx> )fie ccolb MAILING ADD E�S,L. `sg`A�DVDDRESS;CITY,STATE,ZIP): EVENING PHONE: �TL©FEDE�RAL WAY BUSINESS LiCENSSMBE se r etikto & c t FAX NUMBER: CONTRACTORS REGISTRATION NUMBER: i / . L Q � -y EXPIRATION Dlip /'O? (copy of card required) ti (2(2 += 0 S 1,i.q C / 1 / -�J APPLICANT: NAME: --/� DAYTIME PHONE: ) MAILING DREEt ADDRESS;CITY,STATE,IPZ ): EVENING PHONE: RELATIONSHIP TO PROJECT: FAX NUMBER: 0 ARCHITECT ❑TENANT o OTHER(DESCRIBE): ( ) - E-MAIL ADDRESS: CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER ❑APPLICANT ❑CONTRACTOR ■ DETAILED BUILDING INFORMATION EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ CO• V ED PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ SPRINKLERED BUILDING? o YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑YES ❑ NO WATER SERVICE PROVIDER: o LAKEHAVEN ❑ HIGHLINE ❑TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) • . **NEW RESIDENTIAL CONSTRUCTION ONLY** 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 UNIT(S) 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: ❑ELECTRIC O GAS PLUMBING BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S) DISHWASHER(S) RAIN WATER SYS, VACUUM BREAKER(!) a ELECTRIC D GAS DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( ) INTERCEPTOR(S) SUMP(S) ■ bISCLAIMER/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 upplied to the city as a art of this application. NAME/TITLE: (� , � DATE: Le/ ��( ❑ PROPERTY OWNER ❑APPLI NT ONTRACTOR FOR OFFICE USE ONLY: o 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? ❑YES ❑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.citvoffederalway.com IUI,I I i1 i 1 UI t 1_;1l1,101, '\:i1 I II tll t 4 cfrr'vt Bm.DINC DIVISION 33530 First Way South Federal Way,WA 98003 (253)661-0000 Fax(253)661-4129 FIRE PROTECTION SYSTEM APPLICATION Federal Way Business License number: j2 qc-106691_00 E)L Fps • PARCEL 611)-1 0 q g Commercial 57 Residential O SITE LOCATION P Tenant/Owner /[ s� � / tt — A IL // 1, I, A A li s Phone 2_, Address/City/SteteJ7,ip �� t^� / ' Nature of Work (r .N t Its e l LJ 1 i2 .. Qf' Project Valuation:�,�f�J�(f/• C)t.) APPLICANT 4• Name r4. Addresa/City/Stz�ip ' r • 111a 1 -S tt . Cg( C Contact Person t X ��.I _ /,� `_ � Phone -4'coci Ltta.Fax D CONTRACT On Company Name_.._ K�1 t k OP tf LkC P _..' Address/city/St Zip S Contact Person 1 t' . 1 _ _—_ cL Phone p. 4 8Yat)La-La 2.tD [4.0.0c State L&I Contractor Registration# Mardewsr Sepreme.tfel Exp.Date PLEASE SUBMIT THREE(3)SETS OF DRAWINGS AND CUT SHEETS, PER NFPA STANDARDS. MAXIMUM PLAN SHEET SIZE: 24" X36" DISCLAIM BR:r eetity, pro)o(pedviy.that the Inlrmuthe Relished by re Pit emitA P Ina 1 e neI fa- IMO v..vthutdW the Cay OCP,n.t�Wby b ey es I Any.I..and Cettnt fa(batudiy eats, zp u. haw Out t VI,inewtod 6y Me o�t0,n of em bme prynI, to me o meat N tl aPc+*�,enA,rt ream ttk inta,401 evpplied tc @top a iut6'h? nd Els!ep.irrt d.Cid orrede.)'way but only whale eu:h elel m abut out D(tke ranee or the ib d�°tuted m hrva e.nd et end ream.onto e h Prto(UJe.m dStude. 111tN.vhiehmeyhe ..1'ny its najcM.ad ernPbyeM tope the m+n%O(Ne Owner/Agent . ` I �IP YYSArr Date Rirrea 7(19!97