02-105714 PIA4 Cv66 1103.6 •
;°' ` NSTRUC 1 ION PERMIT APPLICATIONp
uV �v G�;� RECEIv CATION NUMBER: oz. - L LL� -lJ
lC 'RAO ,A(}Pl}PjLICATION NUMBER:
DEC 2 3 `-APPLICATION NUMBER: _ _ - - -Laillid
The following is requir r p-ipkelati Lease print(in ink)or type**
11 nn1�;�t� (�WG Dt
Please note: Electrical, Fire Prevention SysternMI I Engineering permits may require a separate application.
. • •- L T .-. V. PROPERTY INFORMATION . .
SITE ADDRESS: �/ ` J k ` --"7 V ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
!.-::-:;•:;'- ::.>.1.;.:*-.:-. ;"';',It;;----•:•7'.
.;-i ... •• ••..!:1[:;.11`PROIECTINFORMATION' ._ .r '`' _
TYPE OF PROJECT(This application): )1 BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): CONSTIZoCT A N LO g i5e:P Ori- Mg Ektrw
Ti '.r t- 1.1-E..9 \A1Lm A-r-r<Y'} Np.P.AC.?
PROJECT NAME: sik 27 Rt €ICr C E flE c_b {- e=_..= t C
. .. .-11 PEOPLE INFORMATION / • . . :I : • - -
PROPERTY OWNER: NAME: DAYTIME PHONE:
cJC.NNECDE.R. MFS \1•4G• (206 )Z48 -247
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
(0510 Soo-nkcen rEe— 9 vc>. TuxiILA,, WI, 981$8
CONTRACTOR: NAME: DAYTIME PHONE:
PC\MADee—A {c s tNIC.-• ( )248 -24i7)
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
405)0 SouTICEmT>:P jL - TUKwaL,A,WA,. ta.lS poi. )2443 -2y7/
CITY OF FEDERAL WAY BUSINESS LICENSE NUMB R: FAX NUMBER:
1 - T9-10_7424-OD- 51.-_ (2Q(.)24Z - 4zd4
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) SG}-In1EI__iG_2-‘45 ea_ - - - D3 /01 / 03
—
APPLICANT: NAME: —
DAYTIME PHONE:
Z &k1EA. (2 )248 -2117 1
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
(05(0 SoutRCE TER-, gi,vt). ii) u Wke lBaQ I ( )2.42. -42_o9
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT LI TENANT A OTHER(DESCRIBE):rr2j• fi\pkyjlif.cieZ, (2rxv )242 - 4209
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT. ❑ CONTRACTOR
. ►•I DETAILED BUILDING INFORMATION• • •
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
'ROPOSED USE: 51?JCq(LE . -1 fi PROPOSED VALUATION FOR IMPROVEMENTS: $ /SQL-C)
SPRINKLERED BUILDING? ❑ YES azin,NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES'I4,NO
WATER SERVICE PROVIDER: ❑ LAKEHAVENHIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ,LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
l/Lf g,/;8
**NEW RESIDENTIAL CONSTRUCTI NLY** ,
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
. 1.1 PROTECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST )1L 3 ) /63
SECOND 1 DZIS 1l.�
THIRD l�
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE 7Z 3 72.."
HOW MANY FLOORS? I
TOTAL: +29__g I Z-9,3 l
...-r... .s:w.:..::;.. .-..->.s,..�.�....-.....*-.4.:.v0.-4.4,iGiro,atri!
vti: ,i e:FIA T UREs.f.,-:ai+,!,,;... r}:.w:+r.....:wailsl+ ,.
Y.. ?id'4',+YW..,;„4t;b.atiw,..4'l:V: w!F..,,, s..
Indicate number of each type of fixture
MECHANICAL , ,60.--o
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) F REFRIG.SYSTEM(S)
BBQ(S) LI FAN(S) 1 HOOD(S) WOODSTOVE(S)
BOILERS) J FIREPLACE INSERT(S) t RANGE(S) MISC.( )
COMPRESSOR(S) f FURNACE(S)
__/ DUCT(S) 3 GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC .AGAS
t.
PLUMBING
2 BATHTUB(S) . q LAVATORY(S) • URINAL(S) , ) WATER HEATER(S)
` 1 DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC )(GAS
DRINKING FOUNTAIN(S) ) SHOWER(S) -.,' 3 WASH MACHINE OUTLET
_
_1GAS PIPE OUTLET(S) 2 SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
-,:.A'DISCLAIMER%SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by meds 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 daim(induding costs,expenses,and attorneys'fees incurred in the
investigation and defense of such daim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the city,induding its officers and employees,upon the accuracy i
of the information supplied to the city as a part of this application.
NAME/TITLE: —.goo- 7 DATE: /-:Z=22.3 -L53
0 PROPERTY OWNER APPLICANT Q CONTRACTOR
•
FOR,OFFICE USE ONLY:
NEW - ❑ADDITION6-1-15h,0 ALTERATION A[1,REPAIR :__[1 TENANT IMPROVEMENT ..-
IcENSUS CODE - '''- -.......' ---',......._4'..---4&,w,,, LOT SIZE. gr A - `fie'
kaiwaitstolw ,na-d� .BUILDING SHELL ONLY? �YES � NCO�`
M AN DESIGNATION - kBASIC"PLAN' - Hyl I NO -�., �'-'
ECTION TOWNSHIP z Y ,N__G_-E .:_-_--7.. NEW A DRESSRE...UIRED? 11(FS 0 NO -
4PLATTED LOT? �YES NO -- _CHANGE OF USE?- _-- L YES --1.1 NO S - Y.
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•N3 BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.dtvorIederalway.com