04-100840 i •°'E° J_ON51 RUCTlV PERMIT APPLICATION IT
CITY Of 01111 APPLICATION NUMBER: 3 A - i tj U Z'L((�- W
Federal Way MAR 1 0 2°04
- -
APPLICATION NUMBER:
• ,,ITY OF FEDERALWA'' APPLICATION NUMBER: - -
�I I LDING DEPT.
"The owing is required information—Please print(in ink)or type"
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
.0 PROPERTY INFORMATION._
SITE ADDRESS: 7 ��5"-- 0-74Ve-• • ASSESSOR'S TAX/PARCEL #: ( 2-Ce CO U - 0 -J 0 0
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PRO]ECT INFORMATION
TYPE OF PROJECT(This application): o BUILDING 0 PLUMBING ❑ MECHANICAL ❑ DEMOLITION
o ELECTRICAL 0 ENGINEERING`IS,,FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): A DP ir 0 C�` 7r 1}-w_E-.'yc,
T A-1--41 I ►'\1 .17--o4 E m T5 .
PROJECT NAME: FL_ \ ,iAY C--\�� A L.L_
`PEOPLE INFORMATION --
PROPERTY OWNER: NAME: DAYTIME PHONE
( ) - I
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: NAME: I DAYTIME PHONE:
F1V--- YSI 5 V2E-Sn (zs3) $33 - 124 0
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP). EVENING PHONE.
2 l a1 E124f)N- A >✓ R7, N , -t? (2-53) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
LI - e cis--3)-735-, 11 -2 00 0 11
CONTRACTOR'S REGISTRATION NUMBER: r t// `'� EXPIEXPIRATIONTION DATE:
5APPL (copy of card required) e 4 �'�� `c ,1 1 4-0 E 1. I (0 / ( / 05-
APPLICANT:
ICANT: NAME: DAYTIME PHONE:
( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
(
RELATIONSHIP TO PROJECT: i FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER ( DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT tsCONTRACTORJAirne— -@ IR-c5y5TEYn 'U(JEST,
co..,
- :-■ DETAILED BUILDING INFORMATION . -
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
•SOPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ S)90.4—
SPRINKLERED BUILDING? $t_YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES XNO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE n TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
1. **NEW RESIDENTIAL CONSTRUCTION O0**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ r
.. ■ PROJECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL •
r= ,
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(S) o 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,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 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. /
-
NAME/TITLE: / DATE: (3/'I /49
❑ PROPERTY OWNER APP CANT )1ONTRACTOR
FOR.OFFICE USE ONLY: :
t];NEW , x,,i IIi ADDITIO: _ �` i]TENANT IMPROVEME
��_ � N'� *i3 ALTERATIONS "��nnREPAIR,�_. -� � ENT�� :..,.
:CENSUS'CODE 4 - 'ads LOT SIZE 4 ""i I . 4 .W.3.'. ''
:ZONING DESIGNATIONS_ , , , , '- BUILDING;SHELL"'ONLY? 0 YES ' ❑ NO; c* .
COMP PLAN'DESIGNATION .. ,, , _ . t„ ABASIC PLAN? - d YESVtci N0. $ ,r .
SECTION 1. -,3TOWNSHIP '"' RANGE V I NEW ADDRESS REQUIRED? ': ❑ YES 0 NO •
PLATTED LOT? ,-❑YES;„;a NO - * v-" CHANGE OF USE?; Y `. , :n YES `':a NO
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COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
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