04-101756 Y _ • ` F.: f5
4%,. RECEIVED
CONSTRUCTION PERMIT APPLICATION
(ATV OF , MAY 0 7 2004 APPLICATION NUMBER: Q l'- 4 /24 .7 _5-6-
Federal Way APPLICATION NUMBER: -
-,i 1OLD D ERAL DEP WAY APPLICATION 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: J4-Pi 0 9 / 1 oa ASSESSOR'S TAX/PARCEL#: -
T LLL 1 r� O "4" lI 1i
LEGAL DESC PT OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
• PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING o MECHANICAL ❑ DEMOLITION
o ELECTRICCAAL ❑ ENGINEERING`afIRE PREVENTION SYSTEM
l
PROJECT DESCRIPTION(Provide detailed description) J 1 I A i _dim., J '/) PA
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Yn i Vi y t o► ! I ._.) i r7C'� rice v' _m__lee,
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PROJECT NAME: 01 IA (C 11"Lti¢ sj ,�Ytte
■ PROJECT INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: NAME: C---. DAYTIME PHONE:
fl) -CI Q., J (Y ;53) 3(e- /?8C.
�A141NG ADDRESS( ��DRE55;CIj,Y STA ZIP): Ak- 9W ENING PHONE: -
CITY(OF FEDERALFWAY BUSINESS LICENSE NUMBER: 1 FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER: Si ")/417
Fs /3 6 EXPIRATION DATE: /
(copy of card required)
APPLICANT: NAS ME ) { C� DAYTIME PHON:-
MAILING 1100 DRESS(STREETf; 7 CITY,NATE ): ' __.0(, 9r EVENING PHONE: -
RELATIONSHIP TO PROJECT: ..Yy`�' r,/y.�.SI�J FAX NUMBER:
0 ARCHITECT ❑TENANT ❑ OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNE t's4APPLICANT o CONTRACTOR
• PROJECT INFORMATION
EXISTING USE: �/j�� y� (EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ /'
PROPOSED USE: CO 1/I I44' t_J JC PROPOSED VALUATION FOR IMPROVEMENTS: $ llp/ 0 0 0
SPRINKLERED BUILDING? iE YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:ZIYES o NO
WATER SERVICE PROVIDER: o LAKEHAVEN ❑ HIGHLINE ❑TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
•
**NEW RESIDENTIAL CONSTRUCTION ONLY**
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: ❑ ELECTRIC o GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) o ELECTRIC ❑ 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 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 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. n
NAME/TITLE: W rl Ca_t DATE: '3I ) (;'4
/
❑ PROPERTY OWNER ❑APPLICANT CONTRACTOR /�
FOR OFFICE USE ONLY:
❑ NEW o ADDITION o ALTERATION ❑ REPAIR ❑TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION : BUILDING SHELL ONLY? ❑YES ❑ NO
COMP PLAN DESIGNATION BASIC PLAN? ❑YES ❑ NO _
SECTION — TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑YES ❑ NO _
PLATTED LOT? o YES ❑ NO CHANGE OF USE? ❑YES ❑ NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.atygffederalway.com