03-105251 -10040... .....,,.._
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CONSTRU PERMIT APPLICATION S
CITY OF 12111.1144...... RECEIVED APPLICATION NUMBER: -1 O 5--I -
Federal Way APPLICATION NUMBER: -
NOV 2 6 2003 !APPLICATION NUMBER: - -
*C; fBUnprino 1 rAeg wil information—Please print(in ink)or type*"
Please note: Electrical,iliALOINGriDEPTystems and Engineering permits may require a separate application.
-- !'/.':PROPERTY INFORMATION -
SITE ADDRESS: -..2.k‘,271 /94. �, , ..;-e t ASSESSOR'S TAX/PARCEL #: 3"3_ 2 Z G_C�- GEl L2..._4- ---
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACHpSEPARATEpDES RIPTION IF LENGT Y): , , t ` TT S. .' I
��S F.A4a3c- tDp.,r fik,6+4- K„'' d -/ ,. sK � i -J ,..0
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p ■.:.. is I a ��.� / /....w, I l G, _ .
CI PRO]ECT INFORMATION _ _.
TYPE OF PROJECT(This application): o BUILDING o PLUMBING 0 MECHANICAL o DEMOLITION
o ELECTRICAL a ENGINEERING o FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): (Jk1 `7' IAA atG'r!aS (r 41^
. / ems' - Sit /' 'L /.>f, badi
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PROJECT NAME: R1b*.0 { Set iA% t4Sedate
' • . FA PEOPLE INFORMATION ,
,
PROPERTY OWNER: NAM // DAYTIME PHONE:
�ss�Ca� l�T` �� (74n4) 72-5--4.1'2.
�,3-
MAILING ADDRESS(STREET DRESS;CITY,STATE,ZIP):
5S-
-- 110r1--.ICL( r (ayS, cd14, gT1(s
CONTRACTOR: ( NAME: , DAYTIME PHONE:
Mk-La/44 (Z6,6) 6 22- 2v ,
��fifiL(�r `f
MAILING ADDRESS(STREET ADDRESS;CITY•STA TEE.
ZIP)" . EVENING PHONE'
l [? !S`.- - 1 b-f- /t/ -- .5e4.1g, Wq /Z� (-2_,04.62-2...
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CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
- - (2Dtc.,) C22 2C Z f
CONTRACTOR'S REGISTRATION NUMBER: n j EXPIRATION DATE: 1
(copy of card required) r L4 - L G 1' 3 Z �`U j / / O
APPLICANT: NAME: DAYTIME
�{-- C [ ^� PHONE" 2 I
MAILING ADDRESS(STREET� ADDRESS;CITY,STATE,ZIP):
� L C(JLH�A' y 4 (Go )ej 4 o -483 4 e.C,
5s� a s L� c�� EV( ENING PHONE*)
? RELATIONSHIP TO PROJECT: i FAX NUMBER:
a ARCHITECT a TENANT }#O1 HER( DESCRIBE): ( ) - i
i
E-MAIL ADDRESS: I
CONTACT PERSON FOR THIS PROJECT: a PROPERTY OWNER p APPLICANT ❑ CONTRACTOR
-• -.• - ;-----• • :•. ...in DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
t PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ ' 7 ' 'D
SPRINKLERED BUILDING? o YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES 0 NO
WATER SERVICE PROVIDER: a LAKEHAVEN 0 HIGHLINE a TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN a HIGHLINE a PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ON* • ..-4.
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• _. ■ PROJECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
EMENT
FIRST
SECOND
THIRD
ill
FOURTH
/�
OTHER FLOORS(DESCRIBE) /
i
DECK
GARAGE
HOW MANY RS?
/ TOTAL:
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.( )
INTERCEPTOR(S) UMP(S)
r1 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 arises out of the reliance of the city,induding its officers and employees,upon the accuracy
of the Information supplied to the city as a part of this application. `
NAME/TITLE: CCS rr ^ ��t/� DATE: 1/ ?-4/(J
❑ PROPERTY OWNER o APPLICANT14,0:0—TRACTOR
FOR OFFICE.USE,ONLY: I
t —10 gip-ADDITION; o ALTERATION ? o REPAIR- ' a TENANTI1 PROVEMENT '';
tCENSUS.'CODE:— ," , r'3 ;LOT.SIZE f, AW ` Zs ', - s xa -
`ZONING DESIGNATION,:' - 'F- F ;:BUILDING SHELI'ONLY? a;YES _o NO 'a t _.
COMP.PLAN DESIGNATION: ;. - ;,t- h BASIC PLAN?, , '0 YES; o NO `
SECTION :TOWNSHIP IRANGEN" _ NEW ADDRESS REQUIRED? -0 YES -,•04,10-7:-f-
.
PLATTEU`LOT?f :3 YES r o NO , k ta t ,'CHANGE OF USE?: o YES r .a'NO r
COMMUNITY DEVELOPMENT SERV[.•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.cItvoffederalway.com