06-101338 05/29/2001,13:29 FAX 2536614129 CITY FEDERALWAY 1002
1100 #31k
4.
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�R RECEIVED CONSTRUCTION PERMIT APPLICATION_
0 \)\> AY APPLICATION NUMBER: _ emit
MAR 2 0 2000 APPLICATION NUMBER: -e-c---1-6_ . _ -- _
CITY OF FEDERAL WAY APPLICATION NUMBER: -
BUILQING DEPT
*The following is requ Ped information—P(ease print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
-. . C --: ' -- n :-':■ PROPERTY INFORMATION -: - -_ + - . - -• - ,_-_--
— -.
X � J SITE ADDRESS: 5r" 37A) MC- 5_ ASSESSOR'S TAX/PARCEL if: ` �' �� -9043
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): '
C)PA 14/44q(KSt/k C--s S
- : :-.. .-:
.'r=.F- .7 . - - ._ - _ - .■ PROTECT INFORMATION - - ..-.---.7-';-::. .. . ..--: .. .- _
TYPE OF PROJECT(This application): [Ti BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING .FIRE PREVENTION SYSTEM
X PROJECT DESCRIPTION (Provide detailed description):
VI sort- (2.) MGw uKE-vxiCA1--- &4WD Mot o- )ik;i s f f e iCSSI ori Sys-r 5
• To f 1 -- f if% Rao)S _ -
PROJECT NAME: I -eC -u
. • .....::.._-.... .:.. ..-..-.::-.1: ,- ... ....--.-...-.--..:m PEOPLE INFORMATION • .: .... - ..• : .
PROPERTY OWNER: NAME: DAYiIMI-PHONE:
V1/4) �y vS-( - (1.53) 83� 3903
MAILING aD"5 (STREET7 l 5AOO'36,, .:TnPK-- s
CONTRACTOR: NAME: J pA1n•+r PH0Ni: 1
f 5 c-1.,6,x_ way (zo(9 ) 540 - -43ob
Mall INC ADDRESS
(T�� T'S SATE,ZIP): t91 CvENIYG GNONE
2()O Ntiz.e :
( Loo ) 314 - (o(o4
01101-FEDERAL WAY BUSINESS LICENSE NUMBER: FN:NUMBkIt:
19-9 - 10(D4Z-oo 3'L- - - - - — — ( 2 ) 34 -454
. i
CONTRACTOR'S REGIETRA1ION NUMBER: EXPIRA1IONN DATE�j� l V 6.�/t�/�//
(tapy of card repulrCOPr S 'Wy JS AD r
- V/l `(r
>. APPLICANT: NAME: (t PMDNk:
(10k1)2o1) ) 1340 _-430,)
MAILING ADORE (.plRCET ill - ' 1 a0D' \ .C`., 1 _�1FalP .� /" EVENING Pi(0 ONE :1 ' J_
RELATIONSHILP/_'--I O PROTECT: FAX NUMBER: 34 4‘61°1/�"
0 ARCHITECT ❑ TENANT E4 OTHER(DESCRIBE): Q ('LO6) '4o- A)t.
E-MAIL AOURE55;
0 CONTACT PERSON FOR THIS PROJECT: L) PROPERTY OWNER ❑ APPLICANT ' SONTRISCTOR
- ... _ • DETAILED BUILDING INFORMATION - •`
r
EXISTING USE: _ EXISTING BUILDING ASSESSED/APPRAISED VALUATION s C�,t�
PROPOSED USE: , PROPOSED VALUATION FOR IMPROVEMENTS: $ 1 ) t00
_ SPRINKLERED BUILDING? 0 YES A NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:; YES ❑ NO
WATER SERVICE PROVIDER: LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: XLAKEltAVEN El IIIGHLINE 0 PRIVATE(SEPTIC)
• I
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ. FT. SQ.FT.
BASEMENT
FIRST
SECOND /,
THIRD ,f
FOURTH
ADDITIONAL FLOORS(DERIBE) r r
DECK(COVERED?)
GARAGE ❑ CARPORT❑ \\\
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated as .: of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LO REFRIG.SYSTEMS
BBQS FANS HOODS(comm. isl) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEAT
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS(Toilet) N MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
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 reliancg,of the city,inc ding is o vers and employees,upon the accuracy of the information supplied to the city as a part of
this application. ///f/t
. 4-
/�f
NAME/TITLEi.' �� DATE 3/? ?/[11/6
Ignature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner 0 Agent 0 Contractor 0 Architect 0 Other
F•
4*Cil USE ONL
o NEW a ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? Q YES n NO BASIC PLAN? ❑YES n NO
ZONING DESIGNATION CHANGE OF USE? o YES n NO
NEW ADDRESS REQUIRED? o YES n NO UP/SEPA/SU? 4 YES a NO
PLATTED LOT? ❑YES ri NO DEMO PERMIT REQUIRED? a YES o NO
Bulletin#100—January 1,2006 Page 2 of 4 k\Handouts\Permit Application