02-102770 �,� c REINED
. CONSTF.TION PERMIT APPLICATION
\>\> FlY JUL 0 2 2002 APPLICATION NUMBER: jg- I O a 77Q-
APPLICATION NUMBER: - -
CITY OF FEDERAL WAY APPLICATION NUMBER: - -
BUILDING DEPT. - - - - - - - - -
**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: 62(9)J /4p44" 4ls.„ ASSESSOR'S TAX/PARCEL#:
Fe-L-) 'AA-0 e)gc,c
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROTECT INFORMATION' _.
TYPE OF PROJECT(This application): ❑ BUILDING El PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERINGN FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): c.-112..i Kl e/Z_ e I 1 I F e_12
1(1R.1-‘1,62,,n CL'-€ l< cAA4ot
PROJECT NAME: 1•.)04..) FED2r fix., (4IL ' (Vltyf`J
■ PEOPLE INFORMATION
PROPERTY OWNER: NAME.:ms
DAYTIME PHONE:
C1CLA-XJ+f (
) -
MAILING ADDRESS(STREET ADDRESS;CITYj$TATE,ZIP:
t�`�
3t405 'AA-tee. s. re.da0 Ai (patigoo
CONTRACTOR: NAME: ' DAYTIME PHONE:
C.o 4 1irn r) �►�-�- c- �_ (`26 `(? - s-741
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
1,4-O MST SE Svi- A A-va, koA -w wz. ( ) 949
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
(Z53) °t Set 2C-)
CONTRACTOR'S REGISTRATION NUMBER: * EXPIRATION DATE:
(
(copy of card required) ` T I ) z u / /7 19603
APPLICANT: NAME: 7 sc / // __ DAYTIME PHONE:
( (?1/l� I vt,�v� �il� Cc �'�c ' ( 2 ) Gl3 j -,5711-
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): 4 �� (� EVENING PHONE:
1.740 /�t ST S ! -
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT OTHER(DESCRIBE): [vri4-retC-Imr ( ) -
E-MAIL ADDRESS: ,/t
CONTACT PERSON FOR THIS PROJECT: CI PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR •,\JJ jj4f ly r2(Jt-C ALQC_te t
■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ j
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ LJ 5 oZ7
SPRINKLERED BUILDING? DYES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: XLLAKEHAVEN ❑ HIGHLINE ❑ TACOMA Cl PRIVATE(WELL)
SEWER SERVICE PROVIDER: NLAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION Y**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROSECT FLOOR AREAS .
FLOOR EXISTING SQ. FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
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)
• ■ 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 informatio supplied toe city as a part of this application.
i 3
NAME/TITLE: V� 1 . DATE: —i —
� 1 _
D PROPERTY •WN R ❑ APPLICANT ❑ CONTRACTOR
FOR;OFFICE USE ONLY:
❑ RE AIR - Li TENANTIMPROVEMENT "
�IEW���t� ADDITION;��, �,.❑ALTERATION; :, �❑��_ P. f �_
;.CEISUS.0 DE ' 4s' zs.,--,
OILING ESIGNATxON L x ,.. " BUILDING SHELL ONLY? l 0 YES 1;16s-t1-1,':!:4','. .',
SIP A07.7DESIGNATION s .1X �` BASIC PLAN? , YES: O n
ECTION4' -.. r�# -I_.
TOWNSHIP _ RANGE _ ` .,. ANEW ADDRESS REQUIRED? :°,��' C��YES ,'�❑ NO�-�
rte_
4PL'ATTED-LOT? ❑YES -NO _", CHANGE OF USE? YES 0 NO-
_
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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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