02-101190 ' l
a a ► Tr SON PERMIT APPLICATION
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VV PLY
• '•it st' 'j , MBER: 02 - )01_ 1_6[(1 P1
II,CiliTION UMBER:
•,' L T1? UMBER: - - -
**The following is required informalINIChi2WPW�IYc)or type**
BUILDING DEPT.
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
•-•;:-.::--.1---. .1.,:.•.:'-':.;.;!-'- -F—;...:.--- ..4.111,PROPERTY INFORMATION -- -.
SITE ADDRESS: / ?36 5--J, 4j,�fj'57',Qee/ ASSESSOR'S TAX/PARCEL It: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
--;.,..'".‘2,,,;::.:-..-,:t:::!:'..',.,'::' .i./ :PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
LI ELECTRICAL ❑ ENGINEERINGIg FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
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PROJECT NAME: 87/I/G FF/�Glv 5/", /e/fee-/
a•:PEOPLE INFORMATION .
PROPERTY OWNER: NAME: zlec( ( )
66 DAYTIME PHONE:
MAI GAD/E P(ST // �.5ET ADDRESS; 4((/J E,ZIP):...
/33' Se. 336 S ter
CONTRACTOR: NAME: DAYTIME PHONE:
E''ER R ee� /i RE A-/n emrs (253 )627 -3799.
5'D RESS(STRE ADDRESS;CITY ATE,ZIP): EVENING` PHONE:
-��s f1�` 1 - Y9 �
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
fikedife 40/ft? 2. 0 - 12 --J 00 9,2/oo- B (2c3)6,z7- 707
CONTRACTOR'S RE STRATION NUMBER: r ,�(,OJQ/ EXPIRATION DATE:
(copy of card required) E aEt f of aao e✓ 6 / j$ 1.01 -
APPLICANT: NAME: DAYTIME PHONE:
_ d/[/�/ g
�sf ( )
M ING AD)(RESS(STREET ADDRES RY,STATE ZIP): EVENING PHONE:
Sib,I e d-1 (01E1/(41 c�R ( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ki.CONTRACTOR
c -DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ ,.®01
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGIILINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION Y**
• r
_ NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
•
■ 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:
■'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: D ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) El ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
•'U-'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 claim arises out of the reliance of the city,induding its officers and employees,upon the accuracy
of the information su�ppl .the city as a part of this application.
NAME/TITLE: / �/ iic DATE: 3 20Z
LIPROP OWNER ElAPPLICANT JO CONTRACTOR //
FOR OFFICE USE ONLY:
0 NEW ;; , Li ADDITION . ❑ ALTERATION ❑ REPAIR : D 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? U YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO CHANGE OF USE? ❑ YES ❑J NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX 253-661-4129
www.cityoffedera IwaY.com