02-103813 (BP.sc_ P .O
«�a
RECEIVED
CONSTRUC I ION PERMIT APPLICATION
VV APPLICATION NUMBER: I
2 - L:.0
FLY SEP o 5 2002 2 -'E
APPLICATION NUMBER: - -
CITY OF FEDERAL WAY APPLICATION NUMBER: - _ _ _
**The followi -ils req Cir a iinformation-Please print(in ink)or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
.:.. • 11 .PROPERTY INFORMATION
SITE ADDRESS: ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
11 °PROTECT INFORMATIO ..
TYPE OF PROJECT(This application): 'BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): Cat. -rRutr .g e2enQYn.} ZI/2.FAVI sit.ijc
Ft0A-k Ly Res Ive \AlrrK Oi. US 12,cror1 A ostE AT-rAcAD CARb,G (Skoic.,-FLAN)
PROJECT NAME: (�� C k '' ''� _ ,
c- thtiLot,(LeA
- - -'1.1 PEOPLE INFORMATION . . :r. : .
PROPERTY OWNER: NAME: DAYTIME PHONE:
ScRNEluE2 Hors \Wc• (z06 )2118 -247/
MAILING ADDRESS(SWEET ADDRESS;QTY,STATE,IIP):
ID5I0 eoUT 't CEOTE2- &vD. "1-uut k A, Wk. 9.81%
CONTRACTOR: NAME: I 1 DAYTIME PHONE:
t 2. Rov&ES INC . (2c6 )249 -247/
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
(�5/d SCOIRC A)r i2, LIV. 7 Fcw/4,,s k/4 98/$3 ( )2A8 -24-71
Q I F FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
L q - g g A_ Crit24 -CoS1,. ( )Z't2 -4201
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy acard required) aCWE•- 245 pa - - - 83 /e1 /03
APPLICANT: NAME: DAYTIME PHONE:
A`?
5Hek ' ' �/ (2a6 )24S -Z17/
MAILING ADDRESS(STREET ADDRESS;
TCITY,STATE,ZIP). EVENING PHONE:
�51oIPS(S�PROv�vvJEC ��T��` -iiiz7 UGAJ 41,,4 (Zo(0 )Z`7g aee 7/
RELATIONSHFAX NUMBER:
❑ ARCHITECT ❑ TENANT OTHER( DESCRIBE):ficj$ 1 t e2 (2c4, )3 -4Z69
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ,APPLICANT. ❑ CONTRACTOR
I•i DETAILED BUILDING INFORMATION '
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: 7 f PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN 124.HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ,'LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
9(190 9c/a?6
**NEW RESIDENTIAL CONSTRUCTION OY** -ID-
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $________________________)
•
. iM PROJECT FLOOR AREAS
FLOOR EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL
BASEMENT -- ---/
ASEMENT
FIRST ��✓ t Obt t)(3 b
SECOND I)I2
5 IJI85
THIRD -- --`---.___..--e,
FOURTH
OTHER FLOORS(DESCRIBE) < 7--- ------- -
DECK "------/-�_� /--�-� �
GARAGE
HOW MANY FLOORS? I 2.I l 2.1
TOTAL: 2 . '0 to 2 t)(40
•.. • -•i...*- - •;+ '-.- • •v.'-.-hesic«i•1-.:•ivrt"x.'R+sEi!-aMAv'.4Iii.:FIXSURES-x.44.+?rw.svi"-fe+:•tw..e.i.a. e.a.,,irt:.,-,..w-`...rsgr.M,a. maaT•vv.w!ki»ia+
Indicate number of each type of fixture
MECHANICAL it )�
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) 1 GAS LOG(S) I REFRIG.SYSTEM(S)
BBQ(S) (- FAN(S) I HOOD(S) WOODSTOVE(S)
BOILER(S) 1 FIREPLACE INSERT(S) 1 RANGE(S) MISC.( )
COMPRESSOR(S) I FURNACE(S)
I DUCT(S)'HEAT5V5. --111-3- GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC XGAS
PLUMBING
iL BATHTUB(S) - 14 LAVATORY(S) URINAL(S) I WATER HEATER(S)
I DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC , ,GAS
DRINKING FOUNTAIN(S) 2SHOWER(S) 1 WASH MACHINE OUTLET
l GAS PIPE OUTLET(S) __ ,�� SINK(S) Z WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
' 4'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 supplied to the city as a part of this application.
NAME/TITLE: 1_ 44( � /74 . � DATE: .5�.�. �
❑ PROPERTY OWNER 0 APPLICANT ❑ CONTRACTOR
,FOR-OFFICE USE:ONLY:*i
�zw�eruweru awxxa .. .. - s sn:rr.�...�
U_EW ,.0;ADD1TION I ALTERATION: :11 LUPAIR *❑,TENANT IMPROVEMENTs�' -
TCENS IS CODE t I .. ::_, 1- IYE .= Vie:it s _ --z-47:1-4,.„--.2—.
� �3 �`i�.t���i-":.S-�C-.��. �c-�+ SLOT ` "�.��" �.:b���b 3 '�a�. `.
4 O G; S'IGNATION -_ - - i7` 0 _ UILDIf GSH L ONLY,On-,...---13,-NO �-
D�.,GNATlOi,- � " :�5 ',BAS �lA ? (E5 O {- -'.
SrCTION ;TOWNSHIP RNGE is , 1 DRESSREQUIRED7b" 'I LES D`_,, a-
Lbji ❑ (ES N ..: ... . 3 M:CHAI GE OF:� SE1.:. .. < _ .:y.ES ,.ns'+1P. ,.
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253 561-4000•FAX:253-661-4129
www.dtvoffedera Iway.com