02-104459 0 •
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�TOf CONSTRUC I ION PERMIT APPLICATION
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RECEIVE
APPLICATION NUMBER: . d 2 - `+ 5 9 _ 0 0
oc( 9 Z�n� APPLICATION NUMBER: -
APPLICATION NUMBER: -
**The following O �Q • /"„• mation-Please print(in ink)or type** 1
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IL.DING " t '_
Please note: Electrical,Fire Preve ion Systems and Engineering permits may require a separate application.
.. ■ PROPERTY INFORMATION
SITE ADDRESS: .--P'25 i/6 --- iikk„ `dam' ASSESSOR'S TAX/PARCEL#: J 2-0.3-�®- Daft.'
LEGAL DESCRIPTION OF SBJECT P PERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
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t ;:.,- 1 'PROTECT INFORMATION'._ ,. -
TYPE OF PROJECT(This application): , BUILDING ❑ PLUMBING ❑ MECHANICA N
❑ ELECTRICAL ■ ENGINEERING❑ FIRE PREVEN[ION SYSTEM
PROJECT DESCRIPTION (Provided .iled descripti,n): ! �� .I 1it
1201 }10/S i° A€t
PROJECT NAME: CG1G�C.r/TAAJ
. ■ PEOPLE INFORMATION
PROPERTY OWNER: NAME: ' DA ME PHO .:
I . VV" MAII G D REE ••'I IIP: uz.� 3 //'/ �j2�7��
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..,-- CONTRACTOR:CONTRACTOR: NAME: DAYTIME PHONE:
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MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FFAX NUMBER:
)
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
( card required) / /
APPLICANT: N DAYTIME PHONE:
MAILING ADDRESS(STREET ADDRESS;CITY,ST,TE,ZIP): / _ / NING��PHON
AIL-.. ti �.
AIC41!".
SNS IP TO P• ECT: A
❑ ARCHITECT El] TENANT '4 OTHER(DESCRIBE): 4r -� '
-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
■ DETAILED BUILDING INFORMATION • .
EXISTING USE:
EXISTING .,--- EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ ` 7
PROPOSED USE: Oie' PROPOSED VALUATION FOR IMPROVEMENTS: $ irJ V
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SPRINKLERED BUILDING? ❑ YES )4 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES KNO
WATER SERVICE PROVIDER: ,LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY** •
NUMBER OF BEDROOMS: . ESTIMATED SELLING PRA $
., ■;PROSECT FLOOR'AREAS . .
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT «,$) / 3 • Ce Co
FIRST �-� .40/ Y /l Q l/ /-1,'—.- !
SECOND
THIRD __---...
FOURTH .„—
OTHER FLOORS(DESCRIBE)
DECK /) Y4 Y
/ / i f (4�
GARAGE �
HOW MANY FLOORS? I �
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TOTAL: _ 1 .--1 * `L
•
„. .,s..;.. ....:..,_ >....'y�:,..• „Ne FIXTURES
..s.;�r�acuoasw!ni�las�is 'f: 4 .i.:w+.r.f.c+:Asaa.i<n. q-ris++:a:..-.+rin)e(ar.w!stt ...
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: ❑ 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.( )
INTERCEPTOR(S) SUMP(S)
.:-:7,-': :::7-k"::.,•'. ''Al'DISCLAIMER/SIGNATURE BLOCK :
I certify under penalty of :erjury that the information furnished by me is true and correct to the best of my knowledge,and
further,that I am authorized •, owner of the above premises to perform the work for which the permit application is made. I
further agree to hold ha - •.. , City of Federal Way as to any claim (including costs,expenses,and attorneys'fees incurred in the
investigation and defe' I 1daim),which may be made by any person,induding the undersigned,and filed against the City of
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Federal Way,but onl .•j claim arises out of the reliance of the city,including its officers and employees,upon the accuracy
of the information .. 7. . . 2 e city as a part of this application.
....._ ..---
NAME/TITLE: Iei,�',' 71 -”: y ? _. DATE: /te
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PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY
VW DADTIOON ❑ALTERATION __❑REPAIR L =TENANT IM.PRO%VE
ENTi€
;CENSUS CO � ' �s LOT SIZE �� � � � x� �x� - ��
O gtIOSGNAIO � W BUILDNGHSLLONLY�3O ES" U NO = l
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CMPtrAi_DSIGN
BASCPAN-- NES' O : $) N
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SCTION rTOWNSH P- '",:RANGE 0 ir _NEWADDRESSrRE UIRED7 A,ftEi•YS ��. . •g.
aPITED'LOT? [' .t140 -CHA460OFUSE? .,E]YENO _ - `
COMMUNITY
DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.dtsioffederaiway.com
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