01-101058 • •
JJ. 19t_
REeEivErCONSTRUCTION PERMIT APPLICATION
E
MAR 9 APPLICATION NUMBER: - 0 t „ '.d= E
2001 APPLICATION NUMBER: -
Y Ui- i-EULHAL WHY APPLICATION NUMBER: -
BUILDING DEPT.
**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: 432 '5 , ?�21 `��cLC a... ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
'C_S—IS)& ..p '��! w "*' Ocz,\O -6! 44 CYJ
• ■ PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING o MECHANICAL 0 DEMOLITION
❑ ELECTRICAL o ENGINEERINGIRE PREVENTION SYSTEM
0))
PROJECT DESCRIPTION(Provide detailed description): AJa*.) J. 67,
r„ k(U
tirn tic-4 C.LLi �.��HC
- WE4* 1. PGJ n<i s �.St!IT'k L t,.i�i«l �cr� cn., , rS.AA L �Kq &i►�,c,.o
t �l -
lAc.r V.(Sk c_44: -r) 1 �& ,rwA-1w.J�-�Al..!1M� \'A ,11.1 A
PROJECT NAME: t�p•,d r �\X .,,`
• !r PEOPLE INFORMATION
PROPERTY OWNER: NAME: ' 1 DAYTIME PHONE:
• MLank- cAQ1 pAJ��
ADDRESS R DRESTATE,
132 5. 3'L 1 `1Aa CA-7-
CONTRACTOR:
isCONTRACTOR: NAME: DAYTIME PHONE:
V.S 017.-•u-- t» (263)1- 3l -z-Z0b
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
(22 0 'S�\t �t IJP ,S�:t�ir� 1C� 4,,..)\c, J t.l A I` 1 ( _' ) -
CITY OF FEDERAL WAY BUSIITSS LICENSE NUMBER: FAX NUMBER:
9. - L Q LB 1 S - 0_ o (2s33o
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
2- 1. 1_ .334_ t I2 /3I /O1
APPLICANT: NAME: DAYTIME PHONE:
C\r.y40CA_ 4 eit_Nr (2.53) -4 - Z2`•t
MAILING AIDBESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
%10 -Alt- S� lltA C1n. �..\EN3 L.-11\ CIQ
1\ c ( � ) — -
2RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT o TENANT /OTHER(DESCRIBE):�C��- o.c"t (,2rj3) 3� 230t‘�
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER o •PLICANT ❑ CONTRACTOR c-aNtIQ•VyGpo.t .C4 th
• DETAILED BUILDING INFORMATION
EXISTING USE: i k4r-Ata c, EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ 7
SPRINKLERED BUILDING? Y7 yES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED. ES ❑ NO
• 0
WATER SERVICE PROVIDER: ❑ LAKEHAVEN o HIGHLINE o TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER: o LAKEHAVEN o HIGHLINE o PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• PROJECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ. FT. TOTAL
BASEMENT
FIRST
'32 14 2-(-lb� _ 3-2�-1 1.wp 5�-r
SECOND (l
:73-z.4 ?_.WL 3z-'I 2.qo
THIRD
FOURTH
OTHER FLOORS(DESCRIBE) •
DECK
GARAGE
HOW MANY FLOORS? , l
TOTAL: (D at-I .
• 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) WOODSTOVE(S)
BOILER(S) ' FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: o ELECTRIC 0 GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) o 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 (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,bu only where such claim arises out of the reliance of the city,including its officers and employees,upon the accuracy
of the informa 'o supplied t• e city as a part of this application.
..
NAME/TITLE: _ • _
_. • DATE: 3"I9'o\
❑ PROPERTY OWNERAPPLICANT ❑ CONTRACTOR