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03-1020672001 13:29 FAX 2536614129 CITY FEDERALWAY 002 �rt•�. CONSTRUCTION CTION PERMIT APPLICATION •VV Ayl- RECEIVED PPT-ICA110N NUMBER: PPLICATIONNUMBER: MAY 2 0 2003 PPLICATION NUMBER: - "cT,h� foil ytj"jgLV iiinformation —Please print (in ink) or type** Please note: Electrical, YF5W1bQ#_9PEAT• [ on Systems and Engineering permits may require a separate application. 14 Y\ SITE ADDRESS: ( Z ,' 33`' : ASSESSOR'S TAX/PARCEL a LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY): 4C_5 1rxk"'►`I / PIMECrMFORNMON TYPE OF PROJECT (This application): C i BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION 0 ELECTRICAL ❑ ENGINEERINGMFIRE PREVENTION SYSTEM X PROJECT DESCRIPTION (Provide detailed description): INS I t tL ChC� I (,A1 5uff fy:%SYsm PROJECT NAME: t PROPERTY OWNER_ NAME: DAY'l MF FHON1: MAI�IN(. ADUkC�S (; iREL7 nOni;l=;<.; CIIY, '�-nTE, ZIP): CONTRACTOR' NAME: � 11,40 MA11 ING AUGRESS (_ i EET A00111:SS; C. fi', ;'i nit, ZIF CvENING Pr+GNE: C117 Or FEDERAL WAY BU:IN.SS Ilt��UMB - - — (N r}b)r.3 J ' (aipof cai R'� REGISTnA 1'iCJN NIIMOEF: 5 0 -'SS M _ — — — — — — EX?IRAQ tON nTE,:� / 3 – (SPY of X14 reQWr[ct) //KO- 111 APPLICANT: NAME: 0AYTI(ZQMEF\ONF:� -43D" MAILING AODRESS (STRCCT ADDU -SS; C.T•, STA,-, 7.IP): EVENING PHONE: 2(Qc�a � sc- / m, 9s( 3 ( ) FEU\noNSHIP'10 PRO]Er: FAX NUMRCR: ❑ ARCHITECT ❑ TENANT O OTHER ( DESCRIBE): ( ) I E-MAIL ADDRESS; CONTACT PERSON FOR THIS PROJECT: LJ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR I ZNFORM4TION EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION • PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ W©O 1� x SPRINKLERED BUILDING? ❑ YES L1 NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) SEWER SERVICE PROVIDE -R: ❑ LAKEHAVEN ri IIIGHLINE ❑ PRIVATL (SEPTIC) _ 05/29/2001 13:29 FAX 2536614129 ;NEW RESIDENTIAL CONSTRUCTION ONLY" NUMBER OF BEDROOMS. BASEMENT FI RST SECOND THIRD FOURTH OTHER FLOORS (DESCRIBE) DECK GARAGE HOW MANY FLOORS? TOTAL: • AIR HANDLING U El NEW El ADDITION ❑ALTERATION 6BQ(S) CENSUS CODE: BOILEFCO ZONING DESIGNATION : MP(S)DUCT COMP PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ NO CITY FEDERALWAY i ESTIMATED SELLING PRICE: ISTING SO" FT. I PROPOSED Sq. Fr. I / TOTAL Indicate number of each type of fixture MECHANICAL X1003 EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM (S) FAN(S) HOOD(S) WOODSTOVE(S) FIREPLACE INSERTS) _ RANGE(S) MISC. ( ) FURNACE(S) GAS PIPE OUTLET(S) HEAT SOURCE: U ELECTRIC ❑ GAS PLUMBING BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S) DLSHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET GAS PIPE OUTLET(S) SINKS) WATER CLOSETS) Misc ( ) INTERCEPTOR(S) SUMP(S) 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 s plied to e P as part of this application. XNAME/TITLE: �� DATE. ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR "= A • FOR OFFICE USE ONLY El NEW El ADDITION ❑ALTERATION ❑REPAIR E] TENANT IMPROVEMENT CENSUS CODE: LOT SIZE: ZONING DESIGNATION : BUILDING SHELL ONLY? ❑ YES ❑ NO COMP PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ NO SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO PLATTED LOT? 0 YES ❑ NO CHANGE OF USc 0 YES ❑ NO