02-101295 sA0 Ilk
• 0
'Mar G RECEIVED CONSTRUCTION PERMIT APPLICATION
--to ECIEFTPIL— APPLICATION NUMBER: 0,2..- 1 I 1� - EPS
• MAR 2 $ 2002 APPLICATION NUMBER; _ _ _ _ _ _ _ —
APPLICATION NUMBER: - '
_
�
**Thee�I *WilWination-Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
P: PROPERTY INFORMATION
SITE ADDRESS: , 0411% (leA" AM,k. . ASSESSOR'S TAX/PARCEL#: _ — — _ _ — — — — —
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROJECT INFORMATION
TYPE OP PROJECT(This application): ❑ , ILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION
0 E ECTRICAL ❑ENGINEERING 4 •E PREVENTION SYSTEM 4--
c_...—....
--
C •.
PROJECT DESCRIPTION`� (Provide detailed description): , _ :__ ,, a..- 7= k .� ,. ...c_ E/1' - . ....
..►�a.�C2 \)c\�OCS'SL V�d�lS t „54`Ma1C�-C—Tho� ck —Ackc.ctlSl?S , �e,a_u3S, \...q S'fYc coo
;,,,-}z.-�.�.../ c 5 '\M 0e.J �V..o/LA /j
L11PROJECT NAME: EDEL\L. VcJI A 1 I-lag 1.1 l-(•rft.L....
)'4 PEOPLE INFORMATION
IIIPROPERTY OWNER: DAYTIME PHONE:
M1- t- 'c`�,Y c Vial t _ (2.5'5) 115- 39;3
N ADDRESS(STREET •`• a� ,STATE,IIP):
INA." S. ??s��^ 'St, 1 C,.tO li� , LAA I ACOS
CONTRACTOR: �l DAYTIME PHONE:
'' .r•�e�s.Tw. (z5 S 3 8 3-45 M to
G ,STATE,ZIP): EVENING PHONE:
39 Wk C. ' % .k.------1--A-e.".....2 11%4(e(, ( ) -
CTIY OF FEDERAL WAY BUSINESS i•; SE NUMBER: FAX NUMBER:
- - ( 5!)) 5`11 - 1'
CONTRACTORS REGISTRATION NUMBER: EXPIRATION DATE:
(copy aP card requred) / /
APPLICANT: � DAYTIME PHONE:
YY<PL.Ek It=+..ltA L. (2lo) Z. 1 - 114(Sb
MAIUNG ADDRESS(SIR ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
2. IC ( 3e S. 1#tab , Prlrz.E , %ld8 ( )
RELATIONSHIP TO PROTECT: ^ FAX NUMBER:
❑ARCHITECT ❑TENANT OTHER(DESCRIBE): ` "e,, - AQP . (2C(o) 1.-11 -15ab
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑PROPERTY OWNER : APPLICANT 0 CONTRACTOR
�� DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: )4-EC}{ If ghL PROPOSED VALUATION FOR IMPROVEMENTS: $ I i Ci.060
• SPRINKLERED BUILDING? ,�YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: YES 0 NO
WATER SERVICE PROVIDER: / 0 LAKEHAVEN o HIGHLINE o TACOMA ❑PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
•
*NEW RESIDENTIAL CONSTRUCTION ONLY**
UMBER OF B ROOMS: 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:
IIII
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING U IT(S) EVAPORA COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) _ ) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT( RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
• DUCT(S) GAS PIPE OUTLETS) HEAT SOURCE: o ELECTRIC o GAS
PLUMBI
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) 0 ELE RIC o GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) C. )
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 informa , , supplied to the city a part o is applica n.
NAME/TITLE: . _ i' afar aL., 1 _ Arm, DATE: /-)), ZS-02-
o PROPERTY OWNER ergEOLICANT 0 CONTRACTOR
FOR OFFICE USE ONLY: I
o NEW 0 ADDITION 0 ALTERATION o REPAIR 0 TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION: BUILDING SHELL ONLY? 0 YES 0 NO
COMP PLAN DESIGNATION BASIC PLAN? 0 YES o NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? 0 YES 0 NO
IIIPLATTED LOT? 0 YES 0 NO CHANGE OF USE? o YES o NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718.253-661-4000•FAX:253-661-4129