03-102769 • ,
RECEIVED
a^p CONSTRUCTION PERMIT APPLICATION
JUL 0 7 2003 APPLICATION NUMBER: `` -
CITY OF FEDERAL WAY APPLICATION NUMBER: -
BUILDING DEPT, APPLICATION NUMBER: -
**The following Is required information—Please print(in ink)or types
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
'/ 9 I (� P-OPEk1 INFt)RPIAIION
SITE ADDRESS: two S. , 3JOI.h J y ASSESSOR'S TAX/PARCEL if: 1, Z 2 L Q Q , c
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ r,RUJeCT INFOI:MAI(o',1
TYPE OF PROJECT(This application): ❑ BUILDING o PLUMBING 0 MECHANICAL 0 DEMOLITION
o ELECTRICAL o ENGINEERING I3 FIRE PREVENTION SYSTEM �^
PROJECT DESCRIPTION(Provide detailed description): 1ii jf I I / 1,- i,T�( �/��,yr��(/- J.•f,qPs�•
PROJECT NAME: CA (//'C"1 of U/G.I,sr,,&
PFIJPLF INF ORPIATION
PROPERTY OWNER: M AE: DAYTIME PHONE:
NAILING ADDRESS(STREET ADDRESS;QTY,STALE,Zur
) v S..?.?o/11 s '. / ,M-<cle.e4 7 1i/.11,
CONTRACTOR: NAME: DAYTIME PHONE:
. Gs,,r ! (2o()L 9
/
MAILING ADDRESS; STATE,ZIP): EVENING PHONE:� 'p u /Le. S-eGeft,,G✓/ - It/at (20e-) 7)o -
CITY FEDERAL
( ) -
FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER: s
Cn � EXPIRATION DATE:
(copy a Qa ) i Ai 8 i L11.2 Z k 8€ c'/ 107 104'
APPLICANT: NAME: DAYTIME PHONE:
l �(-CA/ .r (Z.C) zg( - /5/6?
MAILING ADDRESS(STREET ADDRESS;QTY,STATE,ZIP): EVENING PHONE:
( )
RELATIONSHIP TO TO PROJECT: FAX NUMBER:
❑ARCHITECT ❑TENANT ❑OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑PROPERTY OWNER ❑APPLICANT ❑CONTRACTOR
• [0TAII 0 BO!UAW, INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ (";�,CV('
SPRINKLERED BUILDING? o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES 0 NO
WATER SERVICE PROVIDER: o LAKEHAVEN o HIGHLINE ❑TACOMA ❑PRIVATE(WELL)
SEWER SERVICE PROVIDER: o LAKEHAVEN ❑HIGHLINE ❑ PRIVATE(SEPTIC)
I
S i
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $__
I {Ruff( 7 vtom Ai2i As
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
■ t;:,Tt t'1
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNITS) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
B$Q(S) FANS) HOOD(S) WOODSTOVE(S)
BOILERS) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSORS) FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: 0 ELECTRIC ❑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 OIrTIET
GAS PIPE OUTLETS) SINKS) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
,11'11 R ti13NA11.�:f
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 ar to any dabs(Including assts,expenses,and attorneys'fees incurred In the
investigation and defense of such deka),which may be made by any person,krduding the undersigned,and filed against the City of
Federal Way,but only where Judi deka arbres out of the reliance of the dty,including Its officers and employees,upon the accuracy
of the information suppNed to the city as a part of this application.
NAME/TITLE: 1AT , l t ,' ! DATE: 71/1611
❑PROPERTY OWNER ❑APPLICA T ❑CONTRACTOR
FOR OFFICE USE ONLY: J
0 NEW 0 ADDITION ❑ALTERATION 0 REPAIR ❑TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION: BUILDING SHELL ONLY? to YES ❑NO
COMP PLAN DESIGNATION BASIC PLAN? ❑YES ❑NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑YES ❑NO ^_
PLATTED LOT? 0 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