01-104875 05/29/2001 13:29 FAX 2536614129 CITY FEDERALWAY 21002
IVED "" •
� a MITTE
DEC 2fl� CONSTRUCTION PERMIT APPLICATION_
V �� DECi�eU RXL'WA APPLICATION NUMBER: (�,1 - 3-2-5 1
V RY Gf f BUILDING DEPT. Y APPLICATION NUMBER: _ _ _ _ _ _ z _ _
, APPLICATION NUMBER: - -
"The following is required information-Please print(in ink)or type**
Please note: Electrical,Fire Prevention Syslems and Engineering permits may require a separate application.
- - - - - - • --- ' • -- - 1 PROPERTY INFORMATION -- , - -_ ,
X SITE ADDRESS: 3102 O Hill S ASSESSOR'S TAX/PARCEL if: - -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): '
- -- - - - .- - --- • : ' - - -- ■ PROJECTINFORMAT/ON - - - -- - ----_ _ . - - '
TYPE OF PROJECT(This application): Ii BUILDING ❑ PLUMBING ❑ MECHANICAL 0 DEMOLITION
0 ELECTRICAL 0 ENGINEERINGJFIRE PREVENTION SYSTEM
v PROJECT DESCRIPTION (Provide detailed description):
/� lisle - MC-(,l CN,c'r. t(AL. UwS6 Hoop ti-7)UCr riRG
5 fc-ssMikr sys-ct w -
PROJECT NAME: ft33E T50 S C "" 5 Lt)
■ PEOPLE INFORMATION - -
\j�� PROPERTY OWNER: NAME: RLQ- 5a�5 (.1'2,5)i°Sz.7 - o7D
/ •� fJ
MAILING ADORCSS(STREET ADDRESS;Orr,STATE,ZIP)-
‘1000 14.e . 3319 f 1 VA' A1")) ,l 9033
CONTRACTOR: NAME: oArnMI rHONf:
7t Sf�N�C1'� 5fferi • ( f • ) '0 - 431-*
MAIL ING A RESS(STREET 001U 5S;cm'.STATE,ZIP: CVENING PHONE:
D tR�Pt " WA'/ S 50.111.4- 1UJ1 9%3 ( 20(s) 3 (4- mo
' (IBU5
i•Uf FEDERAL WAY lNF551lilNSE NUMBER:-
— - - - .di 1 8_2- - _ fnX NUMBkR:
( Z 34o —4301
CONTRACTOR'S REGISTI11A21ON NIJMDER:C �j I� �� EXPIRA1 ION DATE.
(copy or awl reQuI �J
rcO) ,l 4 De+s 1-1 0 Ip W p / ( r /CZ -i
NAME: DAYTIME FHON�:
APPLICANT: �}�(E -�pr�se^) ( 204) 34D -x{36
MAILING ADDRESS'T(5V1V•RCCTADORES •CITY,STATE,ZIP): EVENING PI ZONE:
?450 (tt2 uMj S. 5oj\U >W4- %t34 (?.0 ) 314 - t4(a o
RELATIONSHIP 70 PROJECT: ..rn/3r stFAX NUMOCR: d
0 ARCHITECT 0 TENANT HER(DESCRIBE): CY J7I ;"t )1t (tO�p ) 34D - 3b 1 •
.pi
E•MAIL ADDRESS:
S. CONTACT PERSON FOR THIS PROJECT: 0 PROPERTY OWNER 0 APPLICANT 1 4,.CONTRACTOR
-1- _- :- • - - - ' ■ DETAILED BUILDING INFORMATION -
EXISTING USE: _ EXISTING BUILDING ASSESSED/APPRAISED VALUATIONS
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ 2.19040
• x
'� SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ,YES 0 NO
WATER SERVICE PROVIDER: • 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN r1 11IGHLINE 0 PRIVATE(SEPTIC)
05/29/2001 13:29 FAX 2536614129 CITY FEDERALWAY 11003
• ` •
**NEW RESIDENTIAL CONSTRUCTION ONLY•'
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE $ +
. - - _ - : . - ■ PROJECT FLOORAREAS - ,
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT /
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE) 1
DECK
GARAGE
z/
HOW MANY FLOORS? _
TOTAL:
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UN'(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.( )
COMPRESS•• '(S) FURNACE(S)
DUCT(S GAS PIPE OUTLET(S) HEAT SOURCE: 0 ELECTRIC 0 GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) 0 ELECTRIC 0 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 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 informatior s plied city ap a part of this application.
NAME/TITLE: ,M,..
,,,•.e..-._.-- DATE: 1/.4—0 i
•
❑ PROPERTY OWNER 0 APPLICANT ,CONTRACTOR
FOR OFFICE USE ONLY
0 NEW 0 ADDITION 0 ALTERATION ❑ REPAIR 0 TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION: BUILDING SHELL ONLY? 0 YES 0 NO •
COMP PLAN DESIGNATION BASIC PLAN? 0 YES 0 NO .
SECTION TOWNSHIP RANGE NEW ADDRESS RE•UIRED? 0 YES 0 NO
PLATTED LOT? 0 YES 0 NO CHANGE OF USE? 0 YES 0 NO