03-100826 , i � � REC �r� CONSTRU(, ON PERMIT APPLICATION
r . PPLICATiCIi� NUMBER: f��' '
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CITY OF FEDERAL 4b'�v PPLICA'�'iC7�V MIJMBER`. - -
BUILDING DEPT
**The�ollowin9 is roquired informatlon—Please print(in ink)or type**
Please note: EleCtrkal,Fire Prevention Systen�s and Engineering permits may require a sepae�e application.
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SITE ADDRESS: .34�509 91�1i Avrnu�e sontl�,Sri/t+e 105 (Bu%/dinQ P�l7mit#02-105368-00-GIDJ
ASSESSOR'S TAX/PARCEL#: 750451'�0.1�
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TYPE OF PRO7EGT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAI O�EMOLITION
❑ ELEGTRICAL ❑ ENGINEERING X FIRE PREVENTION SYSTEM
PR07ECT DESCRIP7'ION(Provide detailed description):Add and rebcsi+e sprUnklfan,liv��ew Skaep Lab/ocat�d ori N�ee/fiat Bav�!»d�e
noithwest srde of N�e bal/ding`AU e�dsLing sprinkleis sha//be rep/aoed wilfi quicAr�pnn4e type sp�nAders.
PR07ECT NAME: .St', francis Medica/OtKcze Bui/ding S/ee�L�b �„�,
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PROPERTY OWNER: NAME; YTiME PHONE:
Franciscan H�aRh Svsbem (253) 591-6835
MAILING ADDRESS(5TREET ADDRESS;C1TY,STATE,ZIP):
1717 South J Street,Tacoma WA 98405
CONTRACTOR: NAME: pAYRME PHQNE:
�re Stirstema west (253)833-1248
MAILING ADDRESS(SRtEET ADDRE55;CITY,STAIE,21P): EVEMNG PHONE:
219 Froirtsge Road North,SuiEe B; Pacific,WA 98047 (253) 833-1248
QtY OF FEDERAL WAY BUSINE55 LICENSE NUMBER: FAX NUMBER:
19-87-000014-00-BL (253) 735-0113
COMRACTOR'S REGLSTRATION NUMBER: EXPlRATION DATE:
(eopyotea.drequir� PIRESWI14061 10J03/03
APPLICJINT: �E: DAYiIME WiONE:
Paul G.soze (253) 833-1248
MPSLING ADDRE55(Sl'ttEET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
219 Frontage Road North,suice s;Pac�c,wA 9so4� (253) 833-1248
RELATIONSHIP TO PRQ]ECT: FAX NUMBER:
❑ARCHITEGT ❑TENANT X OTHER(DESCRIBE):Project Desip�er (253)833-1248
E-MAiI ADDRESS:
GONTACT PERSON FOR THIS PR07ECT: ❑ PROPERTY OWNER X APPLICANT ❑CONTRACrOR
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EXISTING USE: EXISTING BUILDING ASSESSEQ/APPRAISED VALUATION #
PROPOSED USE: PROPOSED VA�UATION FOR IMPROVEMENTS: �3,996.00
SPRINIQERED BUILDING? X YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIFtED: ❑YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHIINE ❑TAQOMA ❑PRNATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN a HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLtNG PRIC,E: $
'a
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FLOOR EXISTING .FT. PROPOSED .FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
Ind7cate number of each type of focture
MECHANICJ1l
AIR HANDLING UNTf(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) WOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT(Sj RANCE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATfR HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑GAS
DRINIQNG FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
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I certify under penatty of perjury U►at the iMormation furnished by me is true and correct bo the best of my knowiedye,arul
further,that I am authorized by the owner of the above pr�emises bo perform the work for which the permit application is made. i
further agroe to hold harmless the Cily of Federal Way ac�o any ciaim(including cassls,expenses,and attorneys'fea incurred in the
investigatfon and defe�e of such ciaim),whieh may be made by any person,including d�e undersigned,and filed against the City of
Federal War,but only where such claim arises out of the reliance of the ciLy,lncludiny rts officers and empioyees,upon the a�urary
of tlie information wpplied to the city as a part of thls application.
NAME/TITLE: .�ili�.�l.:s�17���,,�,��,�z� DATE: 2/27/03
❑ PROPERTY OWNER o APPLICANT X ODNTRACTOR
�Olt'Q�FICE USE C1�+II.Y•''
o NEW a AQDITION [�ALTERATION' o REPJAIR t7 TENANtT IMPRQ�MEKT '
CENSUSr GObE: ' lQT SIZE:
ZOI�LING'�E9IC�NA'FION':. BUII..f3IHG SH�Lk t)t'ILY?:' Q Y�S (7 NO
COMP PLAN DESIGNAtIUN BASIC PLAN? '�YES o NO
SECiIONI TdW1+1SHIP RANi'aE NEW ADQRESS RE UIRED? ' n'YES � NO
PLATtED�OT? ❑YE5' a N� CFUINGE QF L1SE? Q YES ❑i!1�
COMMUNTfY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661�4000•FAX:253-661-4129
www.citvoftederalway.com