01-104061 � ������`��� CONSTRUCTION PERMIT APPLICATION
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I �� Ry �C,� 2 � ?��� PPLICATION NUMBER: �� — / C� D 1 —� _
f PPLiCATION NUMBER: —
�;a�"v t�F E������a�.i�VAY PPLICATiON Nl�M6ER: - — - -
' BUiLUIiVG DEPT.
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**The following is required information-Please print(in ink)or type**
Please note: Electrical,Fre Prevention Systems and Engineering permits may require a separate application.
• • • • • .
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SITE ADDRESS: __ s34�11 q� AYE Sov�sw. ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
SEsE A�s-TA.c.t�6D 5H�'s6.T �
• . . • •
TYPE OF PRO]ECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
• ❑ ELECTRICAL ❑ ENGINEERING�FIRE PREVENTION SYSTEM
, PROJECT DESCRIPTION(Provide detailed description):
Q.V N b� SPAa�11L.L.E� SvPPI.� L1N E G fAt►n $M NOerE+L �wlrc
'f0 NBN AMISvt�t�o�.�1 SG�a11c.GS EV�L�1NC.` L Nt,E� GdNST��1vt1�R1
f�.�� t.vTE�C.tort Spt,tN�tL4fL 1�..1�R..►� uNflElt SEPAfto.TB Q 'l�Ct�n�T
PROJECTNAME: S?• �1t.s..ac�s AMdv�A-ro� SF..�.v�c�s �V►�D1�1C.
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PROPERTY OWNER' N�E� 1` 1 DAYTIME PHONE:
. ST. FR,.a.�.1c.�S Hoso�-�p.L �/� ST�v4 'PE••�N� �t+�sr•l (�S3) S�!{ - G835
MAILING ADDRF55(S�REET ADDRE55;QTY,STATE,ZIP):
3 S q T�` AvE Tr�.
CONTRAGTOR' NAME: OAYfIME PHONE:
. t.1 Co-�.�s're�c.-r�o�.1 �o• (2csC ) �2¢ -oS3Z
MAILING ADORESS(STREET ADDRE55;QTY,STATE,IIP): EVENING PHONE:
�•o. ��c �9"10 SGw,"tiTCrE WA Q8)0�1 � � -
QTY Of FEOERAI WAY BUSINE55 LI(�NSE NUMBER: FAX NUMBER:
�-o - o o I o 1 45 S-ca�B L (� ) �2q- - ot 82,
CONTRACTORS REGIS�R4TION NUMBER: O(PIRATION DATE:
(�PY of card require� �6.l�(..6�-* �7 Z.r1 O _ CL I I ZC�
APPLICANT: NAME: DAYTIME PHONE:
� S6 �••sT v ,e� Ga. (zcc ) t24 - os-a-:..
MAILING ADDRESS(STREEi ADDRE55;CiIY,STATE,IIP): EVENING PHONE:
�.C. ae�re �►"1'�O SGc.'T'1'l.6 �/� 9�1Oq � � -
� RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑TENANT ❑ OTHER(DESCRIBE):Cnwirtpvrc� ��L�L � ��A'- ���Z-
E-MAIL ADORESS:
CONTACT PERSON FOR TNIS PROJECT: � PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
. . : . • • •
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ '�'
PROPOSED USE �ROPOSED VALUATION FOR IMPROVEMENTS: � �+C�b�,__
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEti�. ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WEIL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**P1EW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: �
• • • • •
FLOOR EXISTING S .FT. PROPOSED S .FT. TOTAL I
BASEMENT
FIRST �
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
OECK
GARAGE
HOW MANY FLOORS?
TOTAL:
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(5) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(5)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) IAVATORY(S) URINAL(S) WATER 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)
I certify under penalty of perjury that the information furnished by me is trve and correct to the best of my knowledge,and
fucther,that I am authorized by the owner of the above premises to perform the work for which the permit application is made. I
furtfier agree to hold harmless the City of Federal Way as to a�y daim(including costs,expenses,and attorneys'fees incurred in the
investigation and defense of such claim),which may be made by any perso�,induding the undersigned,and filed against the City of
Federal Way,but only where such claim arises out of the reliance of the city,induding its officers and employees,upon the accuracy
of the infonnation supplied to the city as a part of this application.
NAME/TITLE: I�VIN/ SM14H � 1�RoS&cx �w,►t�i.i��� DATE: �� � J�I O 1
❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
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FOR OFFlCE USE ONLY: ::.
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'LD NEW:�,'�, 4- �ADDITION ' = ❑ ALTERATION fl ItEPAIR' . ❑=TENANT IMPROVEMENT
CENSUS CODE: LOT3IZE ,.
ZONING�DESIGNATION , BUILDING SHELL ONIY? �� XES � NO
COMP�PLAN DESIGNATION , ; BASIC PLAN? �.;.'-� YES�� �NO
SECTION , -TOWNSHIP ' RANGE NEW ADDRESS REQUIREO? ❑YES O:NO
PLATTED LOT? '. �,YES. ❑ NO GHANGE'OF USE?. `t ❑ YES ❑ NO '
COMMUNITY DEVE�OPMENT SERVICES•33530 RRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253fi61-4000-FAX:253-661�129