03-100675 05/29/2001 13:29 FAX 2536614129 CITY FEDERALWAY x002
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RECEIVED P6
c.;‘. CONSTRUCTION PERMIT APPLICATION
FEB 1 3 2003 APPLICATION NUMBER: f ;- � OQ 7 S` 1 c
0 \)\> AY. 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 - - - - - - - - -•_
r
SITE ADDRESS: .1 L " 1(Q T'. .1 - ASSESSOR'S TAX/PARCEL J: -
-
-
_ -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
14I01 SC H O°L - ow—Tc-Poor
- -a - - . k .,-.-.±--...-. -..- .•.is PROJECT INFORMATION • - 'i:---:F5;:',.."-- . - - -
TYPE OF PROJECT(This application): C7 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION
I-1 ELECTRICAL [Ti ENGINEERING,FIRE PREVENTION SYSTEM�
X PROJECT DESCRIPTION (Provide detailed description): INS- 'l' Neu,) ,.I-t��ti�C-'±-- (1rpgc-i7 kD 'I
ID_ _____________ S4e(zC L S\fS
PROJECT NAME: TO-\\,/I/ IJ 9-i "`0 - \[c k Scl-tut L_ _.
.. IN PEOPLE INFORMATION • .. .. . .. . - • ..-. -- -
PROPERTY OWNER: NAME: DAYT1Mt PHONt.:
feDer w�( 5 - )1sT.. ( )
MAILIN(,ADDRESS(STREET ADDRe. ;CITY,_TATE.ZIP):
...4.
CONTRACTOR: NAME: 0A)1Mt tH0Nt
I
jC 5 180)C � s��� c -oCe > 34b - 3
`,AIIINE ADDRESS(SREET ADDIa:5_;CT',STn
ZIP); CvENING RHONE'.
Ve06 141. �►'�'C(A�"' SI I ( ) -
-(111'01 FEDERAL WAY BUSINESS(ICtN`"c N MBER: �, r,, (7 h-- - FAXNUtnBFlt: i
_-11 t-.-;.‘ ��11 i(p7 I SCS'2 Z/6(0`) ' �° _ 4 3°1 o1
CONI` CTORS REGIS'RAIION NIJMOER: EXPIRA1IOWN DATE:
I (copy or Old revu rcO) ',1"!)& ice"10 �•/Y` / 4 9- / J•• _
APPLICANT: NAME: ' 1 EI I Wv C �:
+ C 4£/ `� I O — l• ! O6l (2. ce)DAYTIME oN3`t J 4j 0
MAILING ADORESS(Sl RCET ;CITY.STATF,7.IP) EH
: vENING PONE:
oo ibiti\MTWq
-C cC-P–— v 13 A ( ) _
RELATIONSHIP)0 PROJECT: FAX NUMOCR: ,j
❑ ARCHITECT 0 TENANT 0 OTHER(DESCRIBE): (% ) 34D - 43 D I
•• E-MAIL ADDRESS;
O CONTACT PERSON FOR THIS PROJECT: Li PROPERTY OWNER ❑ APPLICANT XCONTRACTOR
: :: :-_.-:' "-:- _ -- ■ ;DETAILED BUILDING INFORMATION ..-.': •
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION
• r 23 CSD 00 x
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ d
SPRINKLERED BUILDING? 0 YES Li NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: 0 YES 0 NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN 0 HIGHLINE [Ti TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN [Ti I1IGIILINE 0 PRIVATE-(SEPTIC)
05/29/2001 13:29 FAX 2536614129 CITY FEDERALWAY Ed]003
•
•
• NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE:
. • . .. . . ��PROJECT FLOORAREAS
FLOOR EXISTING SQ FT. PROPOSED SQ. FT. V TOTAL
BASEMENT
FIRST
SECOND f
THIRD %
FOURTH j
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS? _
TOTAL-
_
� " •■-PICTURES` ... .. . .. ..'.r ..
Indicate number of each type of fixture
MECHANICAL
• _ AIR HANDLING UN r(5) EVAPORATIVE COOLER(5) GAS LOGS) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(5)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COM PRESS e,(S) FU RNACE(5)
DUCT(5 GAS PIPE OUTLET(S) HEAT SOURCE: Li ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(5) WATER HEATER(S)
DISHWASHERS) 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)
••-�- • • ==r° DISCLAIMER/SIGNATURE B OC
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 ofhe 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 th city as a part of this application.
NAME/TITLE: DATE: "! 5//O
❑ PROPERTY OWNER 0 APPLICANT CONTRACTOR
FOR OFFICE USE ONLY _
• ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR
0 TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION : BUILDING SHELL ONLY? 0 YES 0 NO - . •
COMP PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ NO .
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES 0 NO
PLATTED LOT? ❑ YES 0 NO CHANGE OF USE? 0 YES 0 NO
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