03-105200 IP
4111111
• E‘_- I V E D
CONSTRUCTIONPERMIT APPLICATION
m•QF G
ECIF— 1— NOV 2 1 2003 APPLICATION NUMBER: Q - LQ 2‘7O=
III APPLICATION NUMBER: _ _ - _ — _ ,. _ —
No
CITY OF FEDERAL WAY APPLICATION NUMBER: _ - _ _ _ , _ — -
4i III 0,Nir. WEPT
**The following is required information-Please print(in Ink)or type** i
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application. t3)
SITE ADDRESS: /0 L/c S. J d ifSJTee f ASSESSOR'S TAX/PARCEL it:
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OP PROJECT(This application): o BUILDING 0 PLUMBING 0 MECHANICAL o DEMOLITION
0 ELECTRICAL o ENGINEERING terfFIRE PREVENTION SYSTEM
a •il,
PROJECT DESCRIPTION(Provide detailed description): JI/J-1-1 L, .1)/C Sap:/o'f'f i Uh ./IM
PROJECT NAME: L i 1,0 (Ate C en+e/
__._._._.________
II,
DAYTIME PHONE: _i
PROPERTY OWNER: I( )
MAILING ADORES(STREET ADDRESS;CITY,STATE,ZIP):
DAYTDHEPHONE:
CONTRACTOR: 5 ,./1emRE ! (706 ) 2
'
f - /y!
MALING App1�5(STREET STATE,ZIP): EVENING PHONE:
(S2o /O/4 dv,,C. S S✓l k/ak4104 144
`,/let!o� (2vG ) M1/ - lIO
]TY OF FEERAL WAY BUSINESSUM86t: FAX NUMBER:
-
- (ZO` ) 2 Gl/ (s-OO
-CONTRACTOREXPIRATSON DATE:
S REGISTRATION
(copy dam ) .0l_ AEL. _ ieH UG 0007 / 0
DAYTIME PHONE:
APPLICANT: NAME:1-4 S'S 4 U Qei (2 ‘) 2
/ -/ /6't
MAILING ADDRESS(STREET ADDRESS; STATE ZIP): EVENING PHONE:
(2' )
730 - 103 7
FAX NUMBER:
RELATIONSHIP TO PROJECT: ( )
0 ARCHITECT ❑TENANT 0 OTHER(DESCRIBE):
/ E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER 16PLICANT o CONTRACTOR
)
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ .7 7g(
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
• SPRINKLERED BUILDING? ❑YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: 0 YES 0 NO
WATER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN o HIGHLINE 0 PRIVATE(SEPTIC)
1111
lb
*NEW RESIDENTIAL CONSTRUCTION ONLY**
• NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
1.: • 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 Value of Mechanical Work: $
AIR HANDLING UNITS) 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.( )
INTERCEPTORS) 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 daim(induding costs,expenses,and attorneys'fees Incurred In the
investigation and defense of such claim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the city,induding Its officers and employees,upon the accuracy
of the information supplied to the dty as a part of this application.
NAME/TITLE: 1, i 4 1i . . DATE: I 1/2 //j
2
o PROPERTY 0 NER ❑ APPLICAN ❑ CONTRACTOR
FOR OFFICE USE ONLY: ;-,
`❑ NEW:k;,,'''ADDITION:.1,1:,'.::::,!::;-
. ..;;':❑ALTERATION sr?.a REPAIR , . O,TENANT IMPROVEMENT° =`., .. •
CENSUSI'CODES.`:Ts,-, ,'*,. ?1... :LOT SIZE:•- f,, -.- _
;ZONING,DESIGNATION, , �. , _.•' :r. `BUILDING SHELL''ONLY? o YES ;.=❑ NO _.
-COMP PLAN DESIGNATION * t: , - - . :-BASIC PLAN?:.-54,;:0 YES ❑'NO
'SECTION:--. . „ TOWNSNIP.x:` , 'RANGE . €iT;? NEW ADDRESS REQUIRED? _- ❑YES-.t ❑ NO
^PLATTEDLOT? ':_❑YES=_,`❑'NO ''-,i'-'70!;"::---.`r CHANGE OF USE? ..7-;-,-,•::-.",-- ❑YES``:❑NO ;
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.dtvoffederalwaV.com