02-105772 * RECEIVED •
Ctr,O G CONSTRUC I ION PERMIT APPLICATION
EOEfKFIL �;,t 2
vv �y DEC 2 7 APPLICATION NUMBER: OL - /Q f'"Z7 - f�
APPLICATION NUMBER: -
CITY OF FEDERAL WAY
BUILDING DEPT APPLICATION NUMBER: - -
**The following is required information–Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
. • - - • ■ PROPERTYINFORMATION -
•
SITE ADDRESS: ' O f2ñi ,( C- i �" ASSESSOR'S TAX/PARCEL#: 79!�pV - 0/10
LEGAL DESCRIPTIO N'OOSUBJECT PROPERTY(ATTACH SE ARATE DESCRIPTION IF LENGTHY):
r
41,444,4"--- -An--
i
-. .�•.... z . .■ PROJECT INFORMATION-:. . . ...-.• . .,.
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): , 02 A.a....m -- ` 4 1-11
(./ /4 t tti
_ 2'44,- _
( ii--dd . --7,, - wi ,16,..., ,,i9 (nil__ t.1-)
421
4044 ANN q It .,-,..4,-,„,- pen.,i,
NAME:
PROJECT ��� ��
. ■ PEOPLE INFORMATION .
T-
PROPERTY OWNER: NAME: DAYTIME PHONE:
MAILING ADDRESS(STREET AD •CITY,STATE,, ):
' 1 o 0 YAG I "y �, c' i1jJG.���j Gi//� qi�Jd,
CONTRACTOR: NAME: DA E PHONE:
/21eo E2ji( Tz:— cX-
) 0275-Teal
MAILING ADQRFSS(S R 1DDRE �,S AATE,^ZIit_ ,/ ^ geltijity�I/ � ON 1 - 1,2 4_;1
CITY OF FE RAL W.Y BUSINESS LICE, E NU1MB L! FXflJ [FJ///7 FAX NUMBER:
l urii9ae to 45-9/ -0v (7- ) f -,
C. • CTOR'S REGISTRATION NUMBER* P /f / L 1117.27,_ EXPIRAIII N DATE:
f.. .require / V Li-T /7 / '� /
APPLICANT: NAME: DAYTIME/ PHONE:
( -uk Tae �;(� ( ) -
MAIUNG ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): 1J�\ EVENINGEEPHONE:
RELATIONSHIP TO PROJECT: ��MTt��T�� �GGX NUM -
❑ ARCHITECT CI TENANT Liz OTHER(DESCRIBE): (((///( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:El YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN El HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTIONNLY**
iii
NUMBER OF BEDROOMS: ESTIMATED SELLING P : $
` ■ PROJECT FLOOR AREAS
FLOOR EXISTING SQ. FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
I
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
,,,,......'..............:!,..,:-.1.14,..1.„7„,:- . ,.,. ';:-h..-.'...+-». i6r-asw*,,,,,wt•:FIXTURES.x;':14,;:.N. -..;.4,-.;.. .>..:3•4:.:M :m.k: ,s-,q:,7.4-.. ...1. ....k. :..
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 ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
:.r - ''7= ."...7':--.'..1:-;',..:-•:. - • ■-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 daim),which may be made by any person,induding 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 appIicatiOn. "`N,,,,_
12
NAME/TITLE: _________ ::_rMfl --1)----- DATE: /. .. 1/ J v
❑ PROPERTY OWNER ❑ APPLICANT LPCONTRACTOR
_FOR OFFICE;USE'ONLY =
[ I,NEW x i❑1AUDITION I /1LTERATION:, . . XfialR 1f1:1 ENANTIMPfiOVEMENT ,
_CENSUS CODE , ''___ Y LOT SIZE s.�`_ i.
ZONING� ESIGNATION-_,-,----„,,—;.?,....3.,:a ,„....,i . N ,SH � l r
BUILDING-SN.. .. _Y•? 31(ES;NV NO s #�
COMP LAN-DESIGNATION ` � 'BASIC PLA„Z:'--4-41 S- " N^
SUCTION 4 wr." DR S. Q<., }� .�
w-,__, TOWNSHIP �_,,,;RANGE= ,,: ,NEW;=,ADDRESS RE UIRED?�.=.� �; � .,� ,,.-�
:PLATTED LOT?- ❑'.YES ,❑ NO_.- CHANGE OF-USE7-= ;;Li YES •[1;NO j ,::?,
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.dtvoffedera IwaY-Com