06-10450705i 28/ 1�001 13 : 28 FAX 253661412S CITY FEDERALWAY Ia 002
RECEIVED
•
CITY OF FEDERAL WAY
BUILDING QEPT.
"The Following is
CONSTRUCTION' PERM�PLICATI UN
pPIJCAIION NUMBER:
�7PPLIiIICC�ATION NUMBER:LATION NUMBER: -
information - Please print (in ink) or type"*
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a Separate application.
Y-1 SITE ADDRESS: L _ ASSESSOR'S TAX/PARCEL a: D — - .d 1
315 to 610 T14 AV1, s
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
CWVIA irt'L-
..;.35! PRwECPINFORMATION - �::%r•_ �:=� .
TYPE OF PROJECT (This application): n BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
11 ELECTRICAL ❑ ENGINEERING,2rFIRE PREVENTION SYSTEM
v PROJECT DESCRiPMTIOL (rPurSovid�de��edAd �crip�ot In,L
X
—f1K-7) WD
PROIECT NAME:
PEGPILE INFORMATION
PROPERTY OWNER:
CONTRACTOR:
FpRAMF,: DAYTIME PHONE::
rnAIUNi: A4DkCi� [STREET nO(7Rt�•-:.CITY. S'TnY<, 7lP):
_ ,� ? oo � �, u ,� —�0 1. LEA �. 4-If- z .
NAME: s1 1 I,CAL))�
MAII_IN(i At1Dr+.ESS (;'I'AEET +SOP 'S. (:rfY. ,rii C. Z!P).-
� o� �
C I i r Sr FEDERAL WAY 0U5lN E55 Iltzf Sa NUMSFR:
C0NTk.nCfOR•5 SEEMS7RAI-JDN NungLk;
(tvpV of caid reciulrm) S � N C 5 5 71 O (11 b _
�C APPLICANT: N+VKE:
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1zEIATI0N7j[N -16 pin
❑ ARCHITECT
CV✓rNif+G FHQNE; \
(Ui -) �Y{a
Fd%x NU 6kR:
(-ab) 340- 0).1..i
E7:PIRAI 0 DnTE• ••
DAYt-.KE Pti7NF:
Y. STaT}, 7_fPPI: 'q� '�{}�}J E/VEWNC; PHONE:
'- FAX N MOCR•
❑ TENANT 6 THER ( DESCRIBE). (- DO M 6 -
EMAIL ADDRESS;
CONTACT PERSON FOR THIS PROJECT: 0 PROPERTY OWNER ❑ APPLICANT I Y rONTSLACTOR I
EXISTING USE:
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
EXISTING BUILDING ASSESSED/APPRAISED VALUATION
PROPOSED VALUATION FOR IMPROVEMENTS: $ 0 5 ° 00 x
❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: M YES ❑ NO
❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ LAKEIIAVEN [I HIGHLINE ❑ PRIVATE- (SEPTIC)
OS/2Q/2001 13:29 FAX 25366141,'a
=NEW RESIDENTIAL CONS P.UUCTION ONLY"
NUMBER OF BEDROOMS:
FLOOR E7
BASEMENT
FIRST'
SECOND
THIRD
FOURTH
OTHER FLOORS (1)PSCRISE)
DECK
GARAGE }
HOW MANY FLOORS' l
TOTAL -
AIR HANDLING U
BBQ(S)
BOILER(S) S COMPREPF[ES5 (5]
CITY FEDERALWAY
ESTIMATED SELLING PRICE:
FT. PROPOSED . FT.
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLERS) GAS LOG(S)
FAN(S) HOOD(S)
FIREPLACE INSERTS) RANGE(S)
FURNACE(S)
U003
TOTAL
REFRIG.SYSTEM(S)
W OODSTOVE(S)
Misc. ( _ }
GAS PIPE OUTLET(S) HEAT SOURCE- (=J ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
r DRINKING FOUNTAINS) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE DUTLEf(S) SINKS) WATER CLOSET(S) _ MISC ( }
INTERCEPTORS) SUMP(S)
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 claim)r which may be made by any person, including 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 sup d to the Ci�y�as a art of this application_ % Lao-
11NAME/TITLE: DATE: PROPERTY OWNER ❑ APPLICANT I CONTRACTOR
FnR OFFICE IMP nNI Y!
❑ NEW ❑ ADDITION ❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE-
LOT SIZF:
ZONING DESIGNATION :
13UILDING SHELL ONLY' ❑ YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? 0 YES 0 NO
CHANGE OF USE? 0 YES 0 NO