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03-102320 0.cEi CONS I RUC N PERMIT APPLICATION CITY OF P"�._./ APPLICATION NUMBER: s - /Q Z 3z-e) -a , (----r- Federal Way JUN 0 5 2-n03 APPLICATION NUMBER: - - CITY OF FEDERAL WAY APPLICATION NUMBER: - - "The irEVJinformation—Please print(in ink)or type** Please note: Electrical, Fire Prevention Systems ano Engineering permits may require a separate application. .R.PROPERTY INFORMATION � — SITE ADDRESS: 3��© '� � — 6 � �� ASSESSOR'S TAX/PARCEL #: �"J �— — - - - - - LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): ,$ ti't"�'�$ X U PROJECT INFORMATION _ _. TYPE OF PROJECT(This application): 0 BUILDING ❑ PLUMBING 0 MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL 0 ENGINEERING ❑ FIRE PREVENTION SYSTEM t PROJECT DESCRIPTION(Provide detailed description): l*rc Q La60 c2iCiA La.-.4-:, L,, K-17- (55° _5 e----\42). LIN-v4--, - s.. ►tis--...1 61/ C ,. _ 6 " 10,..9N2 `.. est rte_..--.. 5,-A.4-\-.-1,..-... ,.J, Z a esti 6 0 i l..� '- '1•42— ,i K—l Z L55" ku s -- PROJECT NAME: L 0 L1'6 S - ■ PEOPLE INFORMATION _ ,_ PROPERTY OWNER: NAME: tt-a w W3 ; DAYTIME PHONE ��rr MAILING ADDRESSv(STREET A DREESE;CITY,STATE,ZIP): ( tt I i PO4),2�6 -��7A I U , cril- 1 . ` 2,M F— TL&L . t L18'08 CONTRACTOR: NAME*EE: ' _`,'��'�`+` �1 DAYTIME PHONE. MAILING ADDRESS k.-QADDRESS, �,S7~AT`EVZIP): �_Q��©6' L�1r / qg __l,EVENING PHONE* q _ 0 IS. s = l� OD 17 f ZtOt )x'71 -/yea CITY OF FEDE''WAY BUSINESS LICENSE NUMBER: f FAX NUMBER:Q) CONTRACTOR'S REGISTRATION NUMBER: i (2°6 )??1+ - - /5®O EXPIRATION DATE: (copy of card required) / / APPLICANT: NAME: l DAYTIME PHONE' MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): lees,.3 EVENING PHONE' V tot A p a 5k�v --c ,..-;10‘.tit,. ( �& ! 42r . ) 4 -a/6 RELATIONSHIP TO PROJECT: D y� FAX NUMBER: 0 ARCHITECT 0 TENANT OTHER ( DESCRIBE): 6 \" E-MAIL ADDRESS: CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER ❑ APPLICANT 0 CONTRACTOR .%„u, V, C.11..•,%1K. �I - - I DETAILED BUILDING INFORMATION EXISTING USE: A EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ "iii 7-464)/(371? PROPOSED USE:a 'EL 34‘.. ,PX-,Y41- r ga 'PROPOSED VALUATION FOR IMPROVEMENTS: $ ii--° �_ SPRINKLERED BUILDING? " .YES ❑ NO FIRE SUPPRESSION SYSTEM 9./REQUIREb:' YES ❑`N. WATER SERVICE PROVIDER: pOrLAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER: 14`LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) **NEW RESIDENTIAL CONSTRUCTION O.* • 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: o ELECTRIC o GAS PLUMBING BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S) DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC o 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 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. y NAME/TITLE: ki\4' "4" — DATE: ‘1‘21 3 l � 111 o PROPERTYOWN'ER 41.APPLICANT o CONTRACTOR .FOR OFFICE USE ONLY i i NEW O ADDi ION C7 ALTERATION ' t REPAIR i7.5TENANT IMPROVEMENT .1 . CENSUS CODE: a .� r " �.: t x g��LOT SIZE "�`��i�,��y�~-�� :-, _'`� �x �'• � :ZONING.DESIGNATION„ rgi? BUILDING SHELL("ILY7 II YES a NO' :' .. COMP PLAN DESIGNATION •. ABASIC PLAN?;' I3 VES Y❑NO; �,„ .�•• SECTION>; t - ' ,,..`�� ,�NEWADDRESSREQUIRED?jam, ❑YE$;� ❑.NO .-" - TOWNSHIP �,� RANGE �;. PLATTED LOT? ,'❑YES ;„ ❑ NO'; ..� " �_ ,CI ANGE OF USE?; *. ❑YES'r-: NO ; COMMUNITY DEVELOPMENT SERVICFS•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129 www