Loading...
01-102156 05/2.9/2001 13:29 FAX 2536614129 CITY FEDERALWAY 2002 41, • G ---, .-- "-., .".,,VED CONSTRUCTION PERMIT APPLICATION uV FfY E�FiL APPLICATION NUMBER: C L - La Z L / -P1 FAY 3 1 7(1,q1 APPLICATION NUMBER: • APPLICATION NUMBER: - ,,' t ;)i r-;_i,c:HAL WAY * The follo�Bi�11 glnformation-Please print(in ink)or type'* Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application. ' . PROPERTY INFORMATION —_ I - - SITE ADDRESS: 1SO 3V1n S ) ASSESSOR'S TAX/PARCEL A: _ LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): r : ■ PROJECT INFORMATION TYPE OF PROJECT(This application): 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING.FIRE PREVENTION SYSTEM X PROJECT DESCRIPTION (Provide detailed description): — a)Ste- CA6Avt 1- c-D HO %t-DUCr. 51Pssl SY S7 --- PROJECT NAME: GDo' • PEOPLE INFORMATION • ,aDL PROPERTY OWNER: NAME: [� DAYTIMI:PHONY: O x , (3,3) z-9 MAILING ADORCLi''(STREET ADDRESS:CITY.STAT.ZIP): �n ,y� O �_ _1 S 30 i 17c h` SIV) 20 l 33 - CONTRACTOR: NAME: GArnM PHONC:46 --- 1 T' 5fgcrib3o- 54C-6-7/ cMAIUN(;AD�55(STREET ADDti:5S;CITY.ZIP):� � � EVENING PHONE: _ L/� D S6 -?(44- !3 ( 1rY Or FEDERAL WAY BUSINESS LICCNSE NUMBER: FAX NUMBI:IL: - _ _©4 lg2-- ( ) - CONTRACTOR'S REGISTRAi ION Nt1M0ER: /EXPIRA ON DATc(6:^ ( copy of cad redutrcd) _ 5h- 1406. S -5 1 G)t C) 1W II 0 ) .. )4 APPLICANT: NAME; �De DATTIM* P (v )54 4So J MAILIN ADDREESI STAD ,STATI,21P): EVENING PHONE: Yitht-T- -Y S 4�h � l 901,34 ( ) _ RELATIONSHIP'10 PROJECT: FAX NUMOCR: 0 ARCHITECT 0 TENANT 0 OTHER(DESCRIBE): ( ) - - "' E-MAIL*DORM: S CONTACT PERSON FOR THIS PROJECT: 0 PROPERTY OWNER 0 APPLICANT 74 CONTRACTOR - : - - - ' - • DETAILED BUILDING INFORMATION ' EXISTING USE: SSED/APPRAISED VALUATION * PROPOSED USE: EXISTING ROPOSE BUILD/NGVALUEA ION FOR IMPROVEMENTS: $ 4-1063 .00 x y. SPRINKLERED BUILDING? 0 YES r 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 El IIIGHLINE 0 PRIVATE(SEPTIC) _ 05/29/20.01 13:29 FAX 2536614129 CITY FEDERALWAY x003 • • ■=NEW RESIDENTIAL CONSTRUCTION ONLY•w NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: ;_ . - - •= -- .. , - ■ PROJECT FLOOR AREAS FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL BASEMENT7 FIRST SECOND THIRD / — /FOURTH OTHER FLOORS(DESCRIBE) DECK z/ GARAGE HOW MANY FLOORS? _ TOTAL: ■ FIXTURES - _ _- - Indicate number of each type of fixture MECHANICAL AIR HANDLING UN r (5) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S) BBQ(5) FAN(S) HOOD(S) WOODSTOVE(5) BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( ) COMPRESS F '(5) FURNACE(S) DUCT(S GAS PIPE OUTLETS) HEAT SOURCE: 0 ELECTRIC 0 GAS PLUMBING BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(5) 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 ofthe 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(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 wheysuch claim arises out of the reliance of the city,including its officers and employees,upon the accuracy , of the informatio pplied ' e ci as a part of this application. NAME/TITLE: _ L DATE: 5(31 /Q X ❑ PROPERTY OWNER 0 APPLICANT I'CONTRACTOR FOR OFFICE USE ONLY ❑ NEW 0 ADDITION 0 ALTERATION 0 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 REQUIRED? El YES 0 NO PLATTED LOT? 0 YES 0 NO CHANGE OF USE? 0 YES ❑_NO ._ _ ..._.. ...... .... twee,n+lo-,ci 441 newt-e...•l!l nr.I.JTIn