02-102782 11)
CONAUC I ION PERMIT APPLICATION
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VV f3YEfL Zf� RECEIVED * .'( PPLICATION NUMBER: Coq - I Qc Q2� o O
JUL 0
3 2002 APPLICATION NUMBER: - -
APPLICATION NUMBER: - -
*Ciaf o ,,g14 formati —Please print(in ink)or type**
BUILDING r..4, ,,
Please note: Electrical, Fire Preve stems and Engineering permits may require a separate application. '`
■ PROPERTY INFORMATION
•
SITE ADDRESS: . ' I�f ' ASSESSOR'S TAX/PARCEL #: 3 q 0 : o _`O D g o
LEGAL DESCRIPTION OF SUBJECT 'ROPER SEPARATE DESCRIPTION IF LENGTHY):
' ``..■ *PROJECT INFORMATION •
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL El DEMOLITION
❑ ELECTRICAL ❑ ENGINEERINGM FIRE PREVENTION SYSTEM
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PROJECT DESCRIPTION (Provide detailed description): +^,'‘ -7_. _ " N 2
.a C-.Fi 12 K-1 G 1; T��-
A
PROJECT NAME: v _ corpo A 1
PE, 'LE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
:� • ' ON G RD6) (, ) `l
MAILING ADDRESS(SIRE DRESS; •,STATE,ZIP):
I CS lc 4 7 PL DC 1Z y kA.;J) ci -Kz;3
CONTRACTOR: N' DAYTIME PHONE:
( )
MAILI ORES EET ADDRESS; A /
R: EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LIGE N - - FAX NUMBE`/R: -
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) / /
APPLICANT: NAME: DAYTIME PHONE:
S C_1'4 CcG?R P 0,1301e-- t_ Iv t e-n-J M sl-T1-', ) ( ' ) '-Z Z - (Z 35 f
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
I 2i-, S. s'}1 sT FL 1- �i L u'JAY \;SIA Disc>C' ( ) -
RELATIONSHIP TO PROJECT: FAX NUMBER:
El ARCHITECT ® TENANT El OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER 0 APPLICANT ❑ CONTRACTOR
■ DETAILED BUILDING INFORMATION
EXISTING USE: d471"--''''''• EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: Cv,"""`�`' PROPOSED VALUATION FOR IMPROVEMENTS: $ •.4.,
SPRINKLERED BUILDING? El YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:El YES El NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
3)1 0i 3)/
**NEW RESIDENTIAL CONSTRUCTION ON •
NUMBER OF BEDROOMS: S T IMiJED SELLING PRICE: $
■ PROTECT FLOOR AREAS
•
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT -
^FIRST 8e.r
S <
/
SECOND 44,4,` '709 . 9s,—4
THIRD j`,'
FOURTH A
OTHER FLOORS(DESCRIBE)
DECK •
t N •
GARAGE / _
/
It
HOW MANY FLOORS?
I . - ..
TOTAL: VT�ph�
.- ....s•...w#iw:.,-'•....iyo.,..';.-:aw«.......,a..e..al. r%ti+✓isralFwsSu>us'vr:.w rrsN.a•FIA/VRGS')CYa.,,,.:-v..ti.M'{...}..« i i»}...z..irni:-.a:.+w+i�'r.� .kfr.ii..
,"
Indicate number of each type of fixture
•
4.
OP
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)SC.
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MI ( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC El GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINALS) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER ❑ E L E CTRC
I ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSETS) 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 toi perform the work for which the permit application is made. I
further agree to hold harmless the Cityof 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 o.f the city,including its officers and employees,upon the accuracy
of the information supplied to the city as apart of this application. —
— 2._—CZ. DATE:
••••• '-°!
NAME/TITLE: .
f ElPROPERTY OWNER El APPLICANT CI CONTRACTOR
iFOR;OFFICE USE ONLY: I
:::4,!,:,-.z.-,
NEw �❑aADDITION ,- ❑ ALTERATION -._ ❑ REPAIR �❑ TENANT IMPROVEMENT
CENSUS:ICODE E � � ' . .. . LOT>SIZE=a. --. . __ ...
OI G ) SIGNATI0N - g � UI1 DI1 G, HELLONLY? ' L]YES'f,'''L] NU
�' COAN�ESIGfVATION7:77 _ BASZC PLA( ? �S _ � NO_ _ _
4_ ECTION ' TOWN41'SHIP ,- RANGE NEIN ADDRESS iEQUIRED?:N....x 'YES NO
.PLATTED:LOT? ❑ YES ❑ NO CHANGE OF USE? ❑YES ❑ NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063 9718••253-661-4000••FAX:253-6,61-4129
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