03-103004 12/27/2001 09:01 FAX 2536614129 CI'1'l FEDERALViAV f7j001
f
AeEIVED •
r
of CONSTRUCTION PERMIT APPLICATION
�E — JUL 2 1 2003 APPLICATIONN M E '
v� l�
40.40 t NUMI R
CITY OF FEDERAL WAY
BUILDING rEc�TP} LTtTION:.NiM
**The following is required information-Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
�•' • PROPERTY INFORMATION
SITE ADDRESS: .;1653 PCC ►C (j(f1 -4 ASSESSOR'S TAX/PARCEL#: -
J
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
(DR0013 .* 3562
■ PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL o DEMOLITION
IR ELECTRICAL o ENGINEERING Fr FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description):
LOW Voui- E f U�12 i.T fir. P 4okiS
x
PROJECT NAME: (2UIZI\J()$ 3SO2' Lo t( �'I�� f-ti evf TT.. ( fini5
• PEOPLE INFORMATION
PROPERTY OWNER: NAME: R('3 I in._.
TT DAYTIME PHONE:
MAILING ADDRESS(STREET ADDRESS;CRY,STATE,ZIP): )
q - --51(_n-LooAvt . NE 1&caMa will 9vg22
CONTRACTOR: NAME: DAYTIME PHONE:
+IRE PRQTCi I(IJ,/ELIC ( L)° ) q(18 - 5763
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
C _313' 04 r.1E S€xI gt12s (24 ) rya — 5763
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
04 — 1 0 2q 9 — QQet (2Q6 ) 11I7 - 5051
CONTRACTORS REGISTRATION NUMBER: / r� /� /� EXPIRA ON DATE:
(copy of cord required) F I t P 1 s U L 4 1 4 1- ,!7 /way /
APPLICANT: NAME: �IS131T
1'�i3 1 DAYTIME PHONE:
CtinJ,Ikk . — Ro`/ L. CSS (4)6 ) v((o - C76.3
MAILING ADDRESS(STREET DRESS;CRY,STATE, ): EVENING PHONE:
Iz o1/s ?151 � jJ� S ;t�- wA 9 12 5..
(1OE ) 'i O - 5 63
RELATIONSHIP TO PROJECT: p FAX NUMBER:
❑ARCHITECT O TENANT OTHER(DESCRIBE): CoktriZA C ro (2.06 ) L{(I - 705(
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: 0 PROPERTY OWNER 0 APPLICANT CONTRACTOR
• DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? X.YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ,DYES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN o HIGHLINE ❑TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE InPRIVATE(SEPTIC)
12/27/2001 09:01 I'AX 2536614129 CITY 11:1/k1011,14AY 2002
• • •
**NEW RESIDENTIAL CONSTRUCTION ONLY**
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) W000STOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(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) ❑ 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 claim(induding costs,expenses,and attorneys'fees incurred in the
investigation and defense of such daim),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 information supplied to the city as a part of this application.
NAME/TITLE: DATE: L`f
o PROPERTY OWNER o APPLICANT CONTRACTOR
RM.•FOR O CE ON Yw>
o:NEW
ti,rLDDiTIx11Y n ALTERAI(SN: .... rsREPAYF
010i7'04P40EM0
SETS CODEY LOT SIZE.;.;
ONING DESIGNATION BUILDING SI LL. tNLY3; Ci ,< O blit
COMP PIAN DESIGi1 ATION BASIC PLAN? O YES .;..3.7 NO. .
SECTION TOWNSHIP ...
R�9N:GE NEW ADt3FtE35 REQiiIF€EI??'. ..::; cI YES> .CF:�iSi
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9716•253-661-4000•FAX:29-661-4129