04-103715 SEP-14-2004 16: 110
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RECEIVED CONSTRUC I ION PERMIT APPLICATION
• CITY OF
SEP 1 6 2004 APPLICATION NUMBER: _ - I ,�,�7
Way 1
Federal y ay APPLICATION NUMBER: _ - _ _ _ _ -
CITY OF FEDFP A, •- APPLICATION NUMBER: _ _ - _ r, T - —
BUILDINC'
**The following Is required Information-Please print(In Ink)or type**
Please note: Electrical,Fire PrevenUor.Systema and Engineering permits may require a separate application.
• PROPERTY INI1ORMATION
SITE ADDRESS; 3V 3(3 e--LASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATT.CH SEPARATED CRIPTION IF ENGTHY
$.I► 111, 9.A _ .�. .1 A .. lk,041k
a
• PROJECI INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
ELECTRICAL ❑ ENGINEERING,❑ FIRE PREVENTION SYSTEM ^� ��j
PROJECT DESCRIPTION(Provide detailed descrlptiOn): V b� \..J�`Y.0 _
PROJECT NAME: 2 r.C1(4,; , C��, � Lf(;)41-
3
■ PROJECT INFORMATION
PROPERTY OWNER: �+"�E:, DAYTIME PHONE:
�LMAILINGA`.E
ribDDRSS(STREET s3>Fsr3Y - SI3Q
3 �c� —TM a . Sv . 5# G � P;4 . 44y '1- ec74
CONTRACTOR: D YTImE R+a+e:
E ZIP): l ) i -°19-45
MARL DR ( ADDRESS;CITY 4: ✓ ✓11� 1�3 IP,. 1 — `r`� I• + i.a/Ah.ix2
1l 11��� CITY OK FEDERAL WAY BUSINESS L CENSE `BER:•IL - \0 55
5 (r () , ( _X NU1-1 )INE - 3O
1\l CONTRACTOR'S REGISTRATION NUMBER 1/7 £*P RATION DATE:
(cvpr of cord nQul»d)
APPLICANT: NAME: --%"�-�' CX l.k `L L DAYTIME PHONE:
/ 1
(��,���+C✓� . •
MAILING ADDRESS(STREET ADDPFSS CITY,STATE,MP): EVENT •,
RELATIONSHIP TO PROJECT: FIX hin4saq.
o ARCHITECT O TENANT o OTHER(DESCRIBE);V`l C. (Cile5M9 -ciao
E-KAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT; PROPERTY OWNER 0 APPLICANT ❑ CONTRACTOR
■ PROJECT INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE; PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? C YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑YES C NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE O TACOMA () PRIVATE(WELL)
SEWER SERVICE PROVIDER; ❑ LAKEHAVEN 0 HIGHLINE p PRIVATE(SEPTIC)
SEP-14-2004 16 11 P.07
"'NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• PROJECT rL_oort AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
A IIXTURES
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) PAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) _ MISC.(
COMPRESSOR(S) - } FURNACE(S)
DUCT(S) 2 GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC 7C GAS
PLUMBING //
BATHTUBS) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ,er GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) �_ WATER CLOSET(S) MISC.( )
INTERCEPTORS) SUMP(S)
i7ISCLAIMER/SIGNATURt 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(Including costs,expenses,and attorneys'Mas Incurred In the
Investigation and defense of Such claim),which may be made by any person,Including the undersigned,and flied 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 su Iled to the city as a part of
this appllmtIon.
NAME/TITLE: DATE 9'l/P''')��!/ IS.
o PROPERTY OWNER ❑APPLICANT NikCONTRACTOR
FOR OFFICE USE ONLY:
❑NEW ❑ADDITION ❑ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE: Y
ZONING DESIGNATION: BUILDING SHELL ONLY? o YES o NO
COMP PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? o YES el NO
PLATTED LOT? o YES o NO CHANGE OF USE? 0 YES o NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO 130x 9718•FEDERAL WAY,WA 98063-9710•253-661-4000•FAX 253-661-4129
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