03-100198 rnror c • GEIVQ !
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Q CONS I RUC 11ON PERMIT APPLICATION
uV FTY JA N j' 5 2003APPLICATION NUMBER: O 3 - ( o v 1 g _
crryoF APPLICATION NUMBER:
- -
��' rLANBL/� ANG�E�TwAy APPLICATION NUMBER: — — - _ _
**Th owing is required information—Please print(in ink)or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
-- • r. .. V. PR7PERTYINFORMATION
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S ADXRESS: 4 �rfr1 r, I i. bSSETAX/PARCE
it
LE c..I DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION F L A II L
Vi1kI:
?`., K ,x i.. ?.1‘`PROJECT INFORMATION'-::::-i.-,:.--:.• .
TYPE OF PROJECT(This application): X BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): CpA.LSTRIAI A JJEL) 3'$ED rOiL JAT't'i
5/KE rM((An -PEstix W(r+i ATTAck C.
PROJECT NAME: V/&S1C PL3
i PEOPLE INFORMATION :
.t_
PROPERTY OWNER: NAME:
DAYTIME PHONE:
cHtsiEADE.a. VloMEs \►tc. (206 )Z48 -247
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
(0510Soo-rikceN r e, 81,VQ. TuKWIt_A 981SS
CONTRACTOR: NAME:
DAYTIME PHONE:
AMn .VEP-AO s INC. (210)248 -2171
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
^ EVENING PHONE:
(� 1Q `mooO? IQTER.- Lir) . TUK w>♦ -A,\a. %1 S r3 (Z04, )215 -2-4171
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER.
FAX NUMBER:
1 `L - `L9:JO(24-oo- }BI—_ (204')24Z - 4zo.c?
CONTRACTOR'S REGISTRATION NUMBER:
.j.�(� �/'-{ V� EXPIRATION DATE:
(copy of card required) Sc._( lL]Il..._-1-_ie►_2_45ea_ - - - D3 /01 / o3
APPLICANT: NAME:
�QJ(D��G��'1. (2`/"DAYTIMETIIM/EE"PHONE)2/:,
-
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): HONE: 2.47 1
EVENING PHONE:
(ZI 0 Sour RCENT€2, &1.4D.7vuwtl_As \TJPk 98(2 (' )24.2 -4�9
RELATIONSHIP TO PROJECT: FAX
FAX NUMBER:
❑ ARCHITECT ❑ TENANT A OTHER(DESCRIBE): p,5. te\ ,,JN eZ (20(0 )24 Z - 4209
E-MAIL ADDRESS: T
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER 4 APPLICANT. ❑ CONTRACTOR
01 DETAILED BUILDING INFORMATION ' . •.
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
ROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES Al NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES A NO
WATER SERVICE PROVIDER: A,LAKEHAVEN ❑ HIGH LINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
**NEW RESIDENTIALCONSTRUCTIO•LY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
i 1 PROJECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT ` -
FIRST 1156 l 16(0
SECOND 4SS p Q5
THIRD a l G�
FOURTH
OTHER FLOORS(DESCRIBE) e
DECK
GARAGE /
HOW MANY FLOORS? I (/4((o (5t
TOTAL: 279 7
279 7
FIXTURES •
.� M•c•• /1•S!•� �::�i.v.>.y.I.s`S".w�i� M +•e:'Sa�Cs3/lMl"M.4.�f{�V:RMtV`IiY`.V II e: �}TY`N��fi!J1�i'�'lLNT'!-J.MI..•A�w�t+irY.J'.I.fli�.�[RL4aaNV�r..,.....2,.„...,-...•
T.f4�..J Y1Q!!l?/A!tf'i.h�
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) I REFRIG.SYSTEM(S)
BBQ(S) L}- FAN(S) I HOOD(S) WOODSTOVE(S)
BOILER(S) 2 FIREPLACE INSERT(S) 1 RANGE(S) MISC.( )
COMPRESSOR(S) I FURNACE(S)
DUCT(S) 4 GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC NI GAS f
PLUMBING
2 BATHTUB(S) 3 LAVATORY(S) • URINAL(S) , WATER HEATER(S)
1 DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC )LGAS
DRINKING FOUNTAIN(S) I SHOWER(S) .,, t WASH MACHINE OUTLET
1 GAS PIPE OUTLET(S) to SINK(S) 2 WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
=.4 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(induding costs,expenses,and attorneys'fees incurred in the
Investigation and defense of such claim),which may be made by any person,induding 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 supplied to the city as a part of this application.
NAME/TITLE: BATE:
❑ PROPERTY,OWNER ❑ APPLICANT Q CONTRACTOR
-FOR OFFICE llSE ONLY
NEWS. :f❑ADDITION... ❑`ALTERATION wg I REPAIR stI3(TENANT IMPROVEMENTP 4
CENSUS.CODE:e :_'4 #,• 1:U7`;SIZE ' k� =c�
ZONING,�ESIGNATI`ON 4,r�- L-7: BUILDING_SHELLONLY?,1-tCllfES L1 NO r ' „-
OMP AN Dl , ,NATION - - BASIC PLAN' I]YESIt �.
110 `"
ECTION � x--:�� ., � 3 ¢
TOWNSHIP GRANGE ' _NE WADDRESSREQUIRED?- ❑,( S 1 O ;,
IPLATTED LOT?` Li YES CI NO CHANGE OF USE?_, l],YFS =LI_,NOF_, 74:57,..;_i-,;,:-.
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL.WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
wwwdtyo0`edera lway.com