03-101015 ` , ��� CONSTRUCI N PERMIT A PLICATION
CITY Of �� ��VE` pp�Cq�ON NUMBER: I.� - (� �� - �� ��
Federal Way AR � 4 2003 PP���ON NUMBER: _ _ = _ _ _ _ _ _ - _ _
M PPLICATION NUMBER: -
Y - - - - - - - - - -
*�The fAl�v' � W orma�ion-"l�ieet(in ink)or type*" �
�� R'1�' °'��' 1��1.
Piease note: Electrical, Fire PreJ'ention Systems and Engineering permits may require a separate application.
. � . � . �
IT DD S: ASSESSOR'S X/ L -
TION ECT PR Y(A ACH P SCRIPTIO GT
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• • � • •
TYPE OF PROJECT(This application): ❑ BUILDING o PUIJMBIfdG o MECHANICAL a DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
� PRO]ECT DESCRIPTION(Provide detailed description): ���p wt Cttw� �✓ �4S i L �4k s
��o?SSo '�
�. �P►L�. �I.F,J1Pz'�'sc.�..�5 � °�B
PROJECTNAME: �,vP_�C�.�JI �L��2� �4S`l C..S
• • • • •
PROPERTY OWNER' NAM : i DAYTIME PHONE: �
�ve SC�►�'� ��-�es ' I.?oc ) 3z3 -�c�s(o ;
MAILING ADORESS(SfREET ADDRESS;CITY,STATE,ZIP):
t �'o?� �o.�-�'ir.tS �vL /�l. #l2S �.�.-2��'4� (�q `I'81�5 i
CONTRACTOR: N^ME: � DAYTIME PHONe: ,
C Y2 S cc►� �o►Ke� � (-���- ) 3 Z 3 - ��� ;
I MAIIING ADDRESS(S7REET ADDRESS;CITY,STATE,Z1P): I EVENING PHONE� �
� !�S f�N'J"�t.(S qV� /`'. �'�Z� SQ�e-{�� �.t�14 F���f� \ oZ-ol.� 7Z� -�E'j�' I
CTiY OF FEOERAL WAY BUSINES$LICENSE NUMBER: � FAX NUMBER: I
- - � (020� ) 3 Z ' `7L Z 1
CONTRACTOR'S REGLSTRATION NUMBER: � IXPIRATION DATE:
��PY of card required) t � �
APPLICANT' NAME: DAYTIME DHONE:
1
o� ��++ow,�s a,� � (�53� 5� s - 75�9 �
MAILING ADORES$(S�REET ADORESS;CIfY,STATE,ZIP): � EVENING PHONE� I
� 5�.�' �Nfi��-s �� ,v. #iZ� �4fn-� W� 9�/�S � (.�-3 ; 5`f - �s�S
RElATIONSHIP TO PRO]ECT: I FAX NUMBER: '
o ARCHITECT ❑TENANT ,1�OTHER(DESCRIBE): �a c.� �4l� �r � �p� � -G 7y Z '
,3-�3 i
iE-MAIL ADDRESS: �
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER �1PPLICANT O CONTRACTOR L I
� . : � � • •
EXISTING USE: V�C��f �� EXISTING BUILDING ASSESSED/APPRAISEO VALUATION ;
PROPOSED USE: S� l.L -�-'r.�r�� �S�N c.� PROPOSED VAtUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? o YES �NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:O YES �NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHIINE O TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE G PRIVATE(SEPTIC)
#*NEW RESIDENTIALCONSTRUCTION ** �oi
'ya�
NUMBER OF BEDROOMS: 3- ESTIMATEU f�a�ING PRICE: �
• • • •
FLOOR EXISTI��,, __ PROPOSED S .Ff. TOTAL
BASEMENT
�� � �. ._—_
�asr �✓ � �3�5 _ J3��
SE�OND �.1/l� /� -� �" � /Z'FS
THIRD �' �a, �"` ,,,� ��
, iJ l� ,. "' ^� rg; . 'gt ,,,f�
FOURTH �
,.. .
� � �� � ,� �„
OTHER FLOORS(DESCRIBE) '� .� �
�-"��4 � �R'_ _
�ECK � � ` �� , ' �
Cpv�Q r pG� �oi�,�J � !� . , �J-i
GARAGE 3�¢r
HOW MANY FLOORS? �I� �%� �gs
TOTAL: �/� 3375 .3 3��
I�dicate number of each type of fi�cture '
MECHANICAL
AIR HANDLING UNIT(S) � _ EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) T FAN(S) � HOOD(S) WOODSTOVE(S)
BOIIER(S) 1 FIREPLACEINSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) 1 FURNACE(S)
/ DUGT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC �GAS
PLUNiBYIdG
� BATHTUB(S) � LAVATORY(S) URINAI(S) � WATER HEATER(S)
� DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC pL GAS
DRINIQNG FOUNTAIN(S) 1 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 true and corcect to the best of my knowledge,and
further,that I am autho�ized by the owner of the above premises to perform the worlc for which the pennit appiication is made. I
fu�the�agree to hold hartniess the City of Federal Way as to any claim(including costs,expenses,and attomeys'fees incurred in the
i�vestigation 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 daim arises out of the reliance of the dty,induding its officers and empioyees,upon the accuracy
of the i�oRnatio�supplied to the city as a part of this application.
NAME/TITLE: � DATE:
❑ PROPERTY OWNER ❑APPLICANT ❑CONTRACTOR
_ _
�;:FOR.O�FICE<l1SE ONLY;,=.
�`�NEW�',��p`�ADDITiON�,;�n,l►LTERATION�M�'_ REPAiR�;�'���.TENANTINIPfiOVEMENT�'�
=CENSUS CODE:���`�,«�.,� x����'�.��: �r',���'� �:COT:SIZE Y�`�����''�';� � -�� .
�ZONING DESIGNATION �.��,�„„����, ,�,��,���BUIL�ING SHELL�ONLI'7.��o YES:�-��i N0.,
� � � � �.. BASICPIAN?.�;�°�YES .'=ti:NO,r�' `" �
COMP PIAN�DEBIGNAT30N .�., .,r��,�,w ,� � " '
=SECTION��� �-�,.TOWNSHIP,;�' , RANGE` ���� , ;1+IEINADDRESSRE UIRED?'`,..� ..��YES -..�o'NO� '
PLATTED LOT7a ..n YES ,.o`NO ���",x'� ��=.. � �FiANGE OF`USE7 -�� - �YES ''`o NO . �`"
COMMUNITY DEVELOPMENT SERVI(FS•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•fAX:253�61-4129
www.citvoffederalway.com