02-101197 4-------
�'. • CONSTRU•ION PERMIT APPLICATION
L RECENEDAPPLICATION NUMBER: aZ - LO L Lq . -EP
APPLICATION NUMBER: -MAR 2 0 2002 APPLICATION NUMBER: - -
**The following is reggicegK9R/siib ease print(ih ink)or type** •
C l Y_ mlu DEPT.
Please note: Electrical, Fire Prevention 5 �rld ngineering permits may require a separate application.
'-'• • _ 1:-PROPERTY INFORMATION ' . -''
SITE ADDRESS: .11215=t S.Ili.). 356 t4 St. . ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
„ ;-a,::.7 . is.-:•.. .1111, PRO]ECTINFORMATION __
TYPE OF PROJECT(This application): ❑ BUILDING El PLUMBING LI MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERINCFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): TEIsLMiT ImPR:ovE74t.eur 04 1 -€
F1 YZE 1414-eM FOIZ - A- /J674) 1c ut&UO.S sAkiowtcm s R.oP .
PROJECT NAME: CPU( ¢YtU .. CO ie0 A-b /Zttnrf11 - C Weu-r-o&L
.,1 " - ' - - -:-:'- ■'PEOPLE INFORMATION .' . - .
PROPERTY OWNER: NAME: DAYTIME PHONE:
(A e.Jv0'5 ( ) -
MAILIN ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: NAME- /��� DAYTIME PHONE:
.. .7E€e W- r '7&1- £4/s%Borg (4,c_ (263 )S38' `44400
AIUNG ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
PO.'(j 3 (Ic4 WA- c?(N38'. ( .lan<.e -
CITY OF FEDERAL WAY BUSINESS UCENSE MBER: _ij FAX NUMBER:
— 1i_ 20 - - - ( ) -
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) = N T E ,e C. S / 0 1 Q C / /
APPLICANT: NAME
DAYTIME PHONE:
-re-ec4--07- Cb.147-4R_ Sys (4,c._ (233 ) 838 -4/4fdb
MAILING ADDRESS(STREET ADDRESS,CITY,STATE,ZIP) EVENING PHONE:
go. (gym 3o 114 et 1�61- rc/d €tO3a ( Set rue.-
RELATIONSHIP TO PROJECT: FAX NUMBER'
❑ ARCHITECT ❑ TENANT OTHER( DESCRIBE): W-5T/}0_1t.4 ( ) -
E-MAIL ADDRES ®UKscrca
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER APPLICANT "ONTRACTOR c,owI-r (.StistNNS,LOIvI
- - - - - " ■ "DETAILED BUILDING INFORMATION'--. '''''-: := .
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ $ ( 6--irr)
SPRINKLERED BUILDING? YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN LI HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION A** •
NUMBER OF BEDROOMS: 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:
•
■ 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: ❑ 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.( )
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 daim(induding costs,expenses,and attorneys'fees incurred in the
investigation and defense of such daim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but only where such daim •ses out of the reliance of the city,induding its officers and employees,upon the accuracy
of the information suppli •ty a part of this application.
NAME/TITLE: DATE: 1)3-/9'---0Z--
0
3-/ OZ.-❑ PROPERTY OWNER APPLICANT eltrUNTRACTOR
FOR OFFICE USE ONLY:
-❑.NEW•_:zti 0 ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
'CENSUS CODE: LOT SIZE: _ -
;ZONING DESIGNATION: BUILDING SHELL ONLY? ❑YES ❑ NO
-COMP_PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ NO •
-SECrIONj3,-_.-, __ TOWNSHIP RANGE_ NEW ADDRESS,REQUIRED? 0 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:253-6A"
www.otyoffederalway.com