03-104577 CEIV P ' CONSTRUCikN PERMIT APPLICATION
CITY of �/ p•
APPLICATION NUMBER: 3-
Federal Way our 0 6 2° APPLICATION NUMBER: _ � 5
C
CITY
FEDDING RADEPWAY kPPLJCATION 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.
■ PROPERTY INFORMATION ..
SITE ADDRESS: 923 54-4-1 2.419 Sl •. ASSESSOR'S TAX/PARCEL tt: J q S _/ 0 - 0 / /J /7812
1 let-itti
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
PRO3ECT INFORMATION
TYPE OF PROJECT(This application): XBUILDING .LUMBING ,AgNECHANICAL 0 DEMOLITION
o ELECTRICAL o ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): CcIHV e4-T' CI'hk1- ?..}c` C 4 vs,,4.4.r 'J '
Ll V t'15 �^z C— TccC.s ( O 6. , +--4°w..., R6C. 124M*". 1 �i,a,,�-2 7' if-PAD fr4 —
CLAP- eyeZ (--.0 Kew. Oft t h i?ebry .
PROJECT NAME: RA `0-E'-
;: `al PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE
CURL MAE— i (2o6 ) 3(ru - aN y
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
ea S w Z i F194). 512'tr C- w,ey , WA . °J 0 2 3
CONTRACTOR: NAME: DAYTIME PHONE
( ) - -
i MAILING ADDRESS(STREET ADDRESS;QTY,STATE.ZIP): �. EVENING PHONE:
140 {I ( )
QTY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
- ( )
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copytard required) % /
#
APPLICANT: NAME DAYTIME PHONE
I
(
)MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE'
( ) -
RELATIONSHIP TO PROJECT: j FAX NUMBER
❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: .ROPERTY OWNER o APPLICANT ❑ CONTRACTOR I
■ DETAILED BUILDING INFORMATION -
EXISTING USE: CDT-R- EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ 62(/ O 0 0
PROPOSED USE: r PROPOSED VALUATION FOR IMPROVEMENTS: $, 7, dao
SPRINKLERED BUILDING? o YES VO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: \LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: 'tLAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ON. •
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 Value of Mechanical Work: $ tat)/
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) F FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) � MISC.(N V1
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) 4 LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC o GAS
DRINKING FOUNTAIN(S) f SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) I WATER CLOSET(S) MISC.(
INTERCEPTOR(S) SUMP(S)
■ DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of per-jury 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 arisesOUt of the reliance of the city,including its officers and employees,upon the accuracy
of the information supplied a ci as a part of this application.
NAME/TITLE: _ 1 DATE: /C)/6/
❑ PROPERTY OWNER o APPLICANT o CONTRACTOR
_.FOR.OFFICE USE ONLY: :-
';t7�NEW ��,�,�,gip ADDITION� .I3 ALTERATION=�� oREPAIR,,�-� O TENANT IMPROVEMENT„_ ,;��...>>
`CENSUS'CODE .4 0:**4 . 4i— P- LOT SIZE:a ,.Ayam k. . ,M ,
;ZONING DESIGNATION, . _ ` _ v, ,BUILDING SHELL ONLY?'o YES �0 NO __
.o YES
.-
.SECTIONS _ TOWNSHIP_ '- RANGE tf NEW ADDRESS REQUIRED? o YES- ❑ NO
PLATTED LOT? o YES. o'NO' :.'CHANGE OF USE? ❑YES"'`t3 NO'
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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