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03-100502 IFENED IV CONSTRUCT� PERMIT APP CATION . CITY OF �.+� APPLICATION NUMBER: jai) - Lv 0- 03_02)2) Federal Way FEB 0 5 2003 APPLICATION NUMBER: - - kPPLICATION NUMBER: - - CITY OF FEDERAL WAY "The folio I r Information—Please print(in ink)or type" Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application. - ■ PROPERTY IMFORMATION ' �} %' S "f' ' --y 2.0 -c sc,,• 32v� Si fZ SITE ADDRESS: 20 2C✓ �C/ ASSESSOR'S TAX/PARCEL #: FEOFI wrr Dq (v 7 LEGAL DESCRIPTION OF SUBJECT PROPERTY(A ACH SEPARATE DESCRIPTION IF LENGTHY): • PROSECT INFORMATION TYPE OF PROJECT(This application): ❑ BUILDING Xsk,LUMBING ❑ MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING ❑ FIRE PREVENTION SYSTEM ) PROJECT DES RIPTION(Provide detailed description): a n 111>t, S) 3 - ` - "/�/ j LSI 0(L vi C. f Q.. 1 I I I I E I I I III r 1 11 0 I //‘ '1-QCt! ' .-6 f /-// %ei( 'a % /4} 7412k , PROJECT NAME: ■ PEOPLE INFORMATION, PROPERTY OWNER: NAME: Ave DAYTIME PHONE: � A.J G/2,197.1 e-A/Q GG ( ) - MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): � I CONTRACTOR: NAME: D PHONE: , , ,/ ben.-Al ..e vice/), CLPo rs) � - i(ec MAILING ADDRESS(STREET AD RESS;CITY,STATE,ZIP): I EVENING PHONE: ( 5 � ( ) - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: � FAX NUMBER: C4)) - ( ) CONTRACTOR'S REGISTRATION NUMBER: �� I EXPIRATION DATE: (copy of card required) Ste' /'' 1c VO / / APPLICANT: NAME DAYTIME PHONE: llAhlIE-) ' I ( ) i MAILING ADDRESS(STRE ADDRESS;CITY ATE, IP): EVENING PHONE: (O�©(1 S eel t L)P- - I ( ) RELATIONSHIP TO PROJECT: r i FAX NUMBER: I I 0 ARCHITECT 0 TENANT OTHER( DESCRIBE): `Qi V� ' ( ) - j E-MAIL ADDRESS: � I CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR - •■ DETAILED BUILDING INFORMATION EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES ❑ NO WATER SERVICE PROVIDER: o LAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC) 515 4-3.)/,,1 **NEW RESIDENTIAL CONSTRUCTION ON • <' • NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ ■ PRO]ECT FLOOR AREAS FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL BASEMENT FIRST SECOND THIRD FOURTH OTHER FLOORS(DESCRIBE) DECK GARAGE HOW MANY FLOORS? TOTAL: 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: ❑ ELECTRIC o GAS PLUMBING BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S) DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC o GAS DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET GAS PIPE OUTLET(S) 1 ,-) SINK(S) WATER CLOSET(S) MISC.( ) INTERCEPTOR(S) MP(S) A 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,but only where such claim arises out of the reliance of the city,including its officers and employees,upon the accuracy of the information supp ied to the city as part of this application. NAME TITLE: evd � / DATE: ❑ PROPERTY OWNER NeAPPLICANT ❑ CONTRACTOR _.FOR OFFICE USE ONLY: p ALTERATION' .- d REPAIR ;TENANT-IMPROVEMENT ADDITION . ,❑ CENSUS CODE: .. LOT SIZE: 'ZONING DESIGNATION: 'BUILDING.SHELVONLY?, ''D YES.t?,D NO COMP PLAN DESIGNATION - BASIC PLAN?,.., YES ❑ NO. SECTION_ TOWNSHIP RANGE - NEW ADDRESS REQ UIRED? , � Q 4`.,:❑YES" ❑ NO PIATTED"LOT?m"o YES ❑ NO `; CHANGE OF USE? :4-1'" ;13 YES ':"'' NO COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129 www,dtvoffed erd IwaY,com