04-101928 .. ........A, 6 411
CONSTRUCT t ION PERMI
CITY OF ..� T APPLICATION
Federal Way C VEO PPLICATION NUMBER: O(I - 1 Q / �,..g- Ft
COMMUNITY OE OFPARTM
PLICATION NUMBER: _ _ -
MAY 2004 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.
`- .` II',PROPERTY INFORMATION
SITE ADDRESS: 2-t of S. 3 2-`-IZ- 5T ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
. I PR07ECT INFORMATION
TYPE OF PROJECT(This application): 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION
0 ELECTRICAL 0 ENGIINEERING it FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): Full-A i,f 7- ,/I 4 s (4 L 06 ✓ - em
�i re Stt f sPeoli 9)t7 A J� VM
i PROJECT NAME: Ue1Moir f (\ 6-0114- Cect4 1-y Cl Gth
PEOPLE INFORMATION
PROPERTY OWNER: NAME:
DAYTIME PHONE-
( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
} I
d
CONTRACTOR: I NAME:
& / O d j DAYTIME
�PHONE:
( /p�
MAILING ADDRESS(STREET ADDRESS;CITY,STATE.ZIP): ( ) - QQ�O
/G/OD C e ctm- /1 '1c^ EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LIC NSENUMBER:
, FAX NUMBER:
JJ
CONTRACTOR'S REGISTRATIO U 8 RO�`l/E 1 I . 0 S S I_ 1 - V D ( O)7 7 - Z-6 d 7
••. of card required) /Q T 1T Li U. 0 D *- 0 g r a L- EXPIRATION DATE:
'/ M
is I � O r C�dS
APPLICANT: NAM
R r f-foap C l3,"kce ncni f fc et J DAYTIME PHONE:
(��) -O 4YD
MAILING ADDRESS(STREET ADDRESS;CITY,STATE.ZIP): (
EVENING PHONE:
(00 I ZI§Ave. S. .pec 7lte C414. R'S/Ids' ; ( )
RELATIONSHIP TO PROJECT: / /
FAX I 0 ARCHITECT O TENANT ptOTHER(DESCRIBE):COKrI'gt-c. t j (2o6)NUMBER
767 - "/07
MAIL ADDRESS:: c'�P ,'-/
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT At CONTRACTOR 1,�yCe Cni# 2Oro6) i40.4
1 DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ t Sod
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:EYES ❑ NO
WATER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE o TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: o LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
1 **NEW RESIDENTIAL CONSTRUCTION ON, 1111
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE:
r ■ PROTECT FLOOR AREAS
FLOOR _. EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
Indicate number of each type of fixture
MECHANICAL Value of Mechanical Work: $
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: o 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.( )
INTERCEPTORS) 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(induding costs,expenses,and attorneys'fees incurred in the
investigation and defense of such daim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the dty,induding its officers and employees,upon the accuracy
of the Information supplied to the ity as art of this application. �+
iuc�� ZerajeGT/4/9e/ DATE: q' " 71° —I
NAME/TITLE:
o PROPERTY OWNER 0 APPLICANT XCONTRACTOR
FOR OFFICE USE ONLY
.0 NEW ii•ADDITION - ' n ALTERATION ' o REPAIR O TENANT IMPROVEMENT" F'
CENSUS toDE ' K4FAWi ,V r;` * r;LOT SIZE Z 4444 .a .t
ZONING DESIGNATION toaini a BUILDING SHELL'ONLY? -0 YES '❑NO
COMP PLAN DESIGNATION Ii BASIC PLAN?" ' -,p YES ``❑ NO
SECTION x6,• TOWNSHIP _„„ RANGE ;NEW ADDRESS REQUIRED? ❑YES ❑ NO
'PLATTED LOT? _5o YES=, _.❑'NO , "M p -' CHANGE OF USE?.` , :. ❑YES;~''-o NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www,citvoffederaiway.com