02-100865 `�r°` G RECEIVED CONSTRUCTION PERMIT APPLICA�ON
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�jV �y PPLICATION NUMBER: Q� - _C�O �� _ �
, � _ ��F� Z 6 1OOZ PPLICATION NUMBER: _ . - -
PPLICATION NiJMBER: - — — — — — - — —
CITY OF FEDERAL WA�( — — — —
� **The fol������1 in ormatiori—Please print(�m ink)or type** �'
Please note:�Electrical,Fire Prevention Systems and Engineering permitr may require a separate application.
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! SITE ADDRESS3 y��s ` / ��'dC. �j'v • Ffj,t7. !�/('7 ASSESSOR'S TAX/PARCEL #: / � � �� � - �♦ � �
LEGAL DESCRIPTION OF SUB]ECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
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• . . • .
TYPE OF PRO]ECT(This application): � BUILDING �PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PRO]ECT DESCRIPTION(Provide detailed description): .�NJI�//i!'!�a.- vF �/
�'L'�o Co 6 y N(I�_/rr�n C�4�G'it.f 1',a �X.�' T-�— G
/I6 e.�, . �c�,�.c�...�-77' Fz�6 �.,.� T fr•r: �.�r.
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P�OJECT NAME: ST. �/l�/�..-C=I N V G�/�'� �O CA�`t�'/l�f
• • • • .
PROPERTYOWNER: NAME: DAYRMEPHONE: /
�2�I�C.�c1�CAr l��It� �� "1.f%�`M (�v'��S9� -��3`�
MAIUNG ADORESS STREET ADDRESS;CifY,SfATE,ZIP):
�`��i� yt����. J'o. ��,��%�,r-c k.,r Gt/� 9�P��3
CONTRACTOR: NAME:
DAYTIME PHONE:
SE�� r�✓ CO.v J���G(�Ur �0�06 )�(� -�//7 �
MAILING AOORESS(STREEf ADORE55;CITY,S7ATE,ZIP): �OQ4X �970 EVENING PHONE: I
oZ c�-7 �/V 6J�C.�F IF'� �¢vt5. /V. SE.HT4 w.�f !09 (o�a 6 ) fs�l - 7770
CITY OF fEDERAL WAY BUS[NESS LICENSE NUMBER: FAX NUMBER:
� o - o o � oi yss_o�_3c r�.� � ��3 - s�o�
CONTRACfOR'S REGIS7RATION NUMBER: EXPIRATION DATE:
(coPy of tard required) � C L � G /� ' 3 7..0 /v � (S �O� � ��
APPLICANT: NAME: � DAYTIME PHONE:
v, f�,����.� /�a f .�;.� (�-t3 ) s'9� -6 83 s�
MAILiNG ADORESS(SfREET ADDRESS;CITY,STATE,ZIP): ����j EVENING PHONE:
3 y s-,,f- y r<'.��F. .1'0. fF�c�,,�c h. a►o o,� (Zs3 )s'9� -�`o Y
REIATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE)�WirE1� ��� )Sg� _(j 8,3,�
E-MAII ADORESS:
CONTACT PERSON FOR THIS PROJECT: �PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR E�E%°�~�''-r�+Gi•^�C�
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EXISTING USE: /� O�Ii1r(i(�C EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ �9'3� M`�C'rp'"�
PROPOSED USE: /�Olo�o G5. /CD Dr� PROPOSED VALUATION FOR IMPROVEMENTS: �_�O O� O O U,n 4
SPRINKLERED BUILDING? �YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSEO/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: �,LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: �AKEHAVEN ❑ HIGNLINE ❑ PRIVATE(SEPTIC)
#*NE1Fl/RESIOENTIAL CONSTRUCTION( **
NUMBER OF BEOROOMS: ESTIMATEU SELLING PRICE: �
• . • . -
• FLOOR �IXISTING S .FT. � PROPOSEO S .FT. TOTAL
� BASEMEKI' ' _ .
�`� d 2� b
SECOND
THIRO
FOURTH
OTHER FLOORS(DESCRIBE)
OECK
GARAGE
HOW MANY FIOORS?
TOTAL:
Indicate number of each type of fixture - � .
MECHANICAL
AIR NANDIING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(�)
BBQ(S) FAIV(S) HO00(S) WOODSTOV�(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.� _)
OOMPRESSOR(S) FURNACE(S) �
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) d N E LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS ,
DRINiQNG FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLEf
GAS PIPE OUTI.ET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
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I certify under penalty of perjury that the informatio�fumished by me is true and correct to the best of my knowledge,and
furtfier,that I am autho�zed by the owner of tfie above premises to perform the work fo�which the perntit app(ication is made. I j
furthec agcee to hold harmless the Gty of Federal Way as to any daim(indudi�g costs,expenses,a�d attorneys'fees incurred in the I
i�vestigation and defense of such daim),which may be made by any person,indudi�g tfie u�dersig�ed,a�d filed against the City of
Federal Way,but only whe� ch daim anses out of the�eliance of the dty,i�duding its officers and empioyees,upon the aax�racy
of the i�foRnation suppli t the dty as a part of this application.
NAME/TITLE: E��r� �/"J/�''�< <��"DATE: � � � �—� '?
/L(/1`.-.�GBrti /�f{._1'_
❑ PROPERTY OWN �APP NT ❑ CONTRACTOR
;FOR QFFICE'USE ONLY: ':'
_......._.... _ _ _.._ .._
+❑ NE1A/ �� ADDITION ; ❑ Al'fERA`{ION :: �;;.R£PAIR--- �TENANTIMPROVEMENT
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'CENSUS CODE:! ` - ` LOT�SIZE --..- - `
;;�ONING DESIGNATION: BUTLDING SNELL,ONLY? ❑Y.ES- � NO
=COMP PLAN DESIGNATION BASIC P.U1K? � YES ❑':Na
SECTION , _ : TOWNSHIP' RANGE. ; NEW AQDRESS fLEQUIRED? ❑iYES ;O NO
PIATiEU.LOT? ❑ YES . ❑ NO CHANGE OF USE? ❑YES � NO '
COMMUNCfY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTN•PO BOX 9718•fE�ERAI WAY,WA 98063-9718-253-661�000•FAX:253{i61-4129
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