04-103350 411 II
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414
RECEIVED CONSTRUCTION PE IT APPLICATION
CITY OF . O L 6 3.3 SD-I- P
APPLICATION NUMBER:'
Federal Way AUG 2 3 2004 APPLICATION NUMBER:' - - _ - _ _ -
CITY OF FEDERAL WAIF APPLICATION NUMBER: _ _ _ _ _ _ _ - _ -
**The follo@iing #NagiiFal nformation-Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
• PROPERTY INFORMATION
SITE ADDRESS:3.2 aol `J.3 A-'1 ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): cop1 (( 1306 ..
A-N(144 Fri_ U IPP L1 T. 1 . - I-( F(.O
• PROJECT INFORMATION
TYPE OF PROJECT(This application): o BUILDING o PLUMBING ❑ MECHANICAL o DEMOLITION 7 Flee. / LA12v1
❑ ELECTRICAL ❑ ENGINEERING RE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): A 6JD 6.4> tel. ALA-awl Dim(CES —O
AO D(tM.A-1- S U P P L`( r.l . )4- 4.m_ E L E cre!G I L L te-t u el 3- Ik)61A-L L(k)6,,
cp.�?.C(S(O i0 A( pjvl O bl 2 ptiLu-t t vO 6 „I-. --k- z l-i►.p 4c?
PROJECT NAME: ,-Nl W\fL_ JUPPLF_ e TOSS •'3 LD 6. (u • t-ocip
• PROJECT INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
MAILI DREL ETA ;CIIY`,''/fy.Z ST P): ca o 1-6 s - 1 I -
PO LC ( (i4l{4ct sm---n-L2.1W4 Q '( dLt
CONTRACTOR: NAME: DAYTIME PHONE:
it I. M 2 cc (e-- (has) q073 -p5
MAILING ADDRESS(STREyET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
89,71- 144"--Aui_ lel). 30IT2 A ihUkILtPO► t4)f- 1 i e ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: I FAX NUMBER:
19 • 13 I Io3 IotT • a0 • 6 L- - (105)ago -6-nit
CONTRACTOR'S REGISTRATION NUMBER:
/� �/^ EXPIRATION DATE:
4
(copy of card required) It 14(\ L. L. k .0 a / /
APPLICANT: NAME: DAYTIME PHONNE:
P1ps (O L } l A
I I b
MAILING (s 1 DRt CITY.STATE,ZIP): EVENINGPHONE:
9 (
00
-ti.DETO J � m 11-LL Balt 50112 1NO O /20,317 (AX NUMBER:
RELATElARCHITECT ❑TENANT k4 OTHER(DESCRIBE):i U8•Co dQT2A-Cree (1125) bei'1- A 1 t-3-
E-MAIL ApDRESS:
CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER XAPPLICANT o CONTRACTOR ---
•
■ PROJECT INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION 6. 00
$
PROPOSED USE: _ _ . _ __ `.(PROPOSED VALUATION FOR IMPROVEMENTS: $ S1 6
SPRINKLERED BUILDING? ❑ YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: o YES o NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN o HIGHLINE o TACOMA o PRIVATE(
WELL)
SEWER SERVICE PROVIDER: o LAKEHAVEN o HIGHLINE o PRIVATE(SEPTIC)
II
a **NEW RESkJENTIAL CONSTRUCTION ONLY'R*
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
I 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: o ELECTRIC o GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC o 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.
NAME/TITLE: i64((2 DATE: F - 00- 09
❑ PROPERTY OWNER o APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
o NEW ❑ADDITION ❑ALTERATION ❑ REPAIR ❑TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONINGDESIGNATION BUILDING SHELL ONLY? ❑YES ❑NO
COMP PLAN DESIGNATION BASIC PLAN? ❑YES o NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑YES o NO
PLAITED LOT? ❑YES o NO CHANGE OF USE? ❑YES ❑NO
i
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.atvoffederalway.com
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