02-104008 05/29/2001 13:29 FAX 2536614129 CITY FEDERALWAY Q002
RE ICED -
42
�?V Rye' OF FEDERALWAY APPLICATION NUMBER: - �_ _ FP
C BUILDING DEPT. APPLICATION NUMBER: _ _ _ _ _
APPLICATION NUMBER: -_
_ z
"The following is required information—Please print(in ink)or type'*
Please note: Electrical.Fire Prevention Systems and Engineering permits may require a separate application.
- . - . - - U PROPERTY INFORMATION - _- -
Q •
SITE ADDRESS: �I • _ ASSESSOR'S TAX/PARCEL II: - —
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): '
•
.■ PROJECT INFORMATION - - -
TYPE OF PROJECT(This application): El BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION
I- ELECTRICAL 0 ENGINEERING,FIRE PREVENTION SYSTEM
x PROJECT DESCRIPTION
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Pt vfdn detailedd n n)11to *---)U
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Skiff)( & s sAT (U -301 ) _
PROJECT NAME: gatill ,n (u„L tw t )
- : . .■ PEOPLE INFORMATION . .
PROPERTY OWNER: NAME: Lift, yvvii (AMMO:PNONI::
I
) .- ) - I
MAILINLI AOORCSS(STREET AO011EVi.:Cirr.STATE.ZIP):
•
CONTRACTOR: NAME: EiAITIMF PMONC: --,
MAII NG AOORESS(STREET AOONt SS;C'TY.STATE,Z ): CVENING PHONE:
240 ()-t(LPc1M'tAM S , 51 1 W� ( ) -
(tiY Uf FEDERAL WAY BUSINESS 11itNSc NUMBER:— ,l /) _ _ (N)(0)�34 A34) I
CONYRACTOR'S REGISfRAI'ION NUMOER: GQ�`1�ylr�t (� EXPIWa ION GATE:
( of Clue requital) '1 T N i 6 S S 21 V P I ( 9- /,
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APPLICANT: NAME: C I( ) ( ME WOW ID 43
MAILING (�CCTAOORESS:G'TY.STATE,ZIP:, _ 1 (2 EVENING PONE:111 - 664)
RELATIONSNIII''I0 PRO]ECT:�,}(M//! S FAX NNf UY1M�_IiCR:3 ,}}��(,0�U
❑ ARCHITECT 0 TENANT • OTHER(DESCRIBE) ('7 ) 3��- `3/)I .
E-MAIL AOORE55:
CONTACT PERSON FOR THIS PROJECT: 0 PROPERTY OWNER 0 APPLICANT CONTRACTOR
.- : ■ :DETAILED BUILDING INFORMATION -
EXISTING USE: _ EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ t1,5 'D 0 A
SPRINKLERED BUILDING? jiYES l) NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: YES 0 NO
WATER SERVICE PROVIDER: • 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN rl i4IGHLINE 0 PRIVATE(SEPTIC)
OS/29/2001 13:29 FAX 2536614129 CITY FEDERALWAY �OQ .0
. — ^ ,
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;NEW RESIDENTIAL CONSTRUCTION ONLY''''
L NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: i — r
■ PRO]ECT FLOOR AREAS - -
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST •
SECOND /7
THIRD
FOURTH —
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UN►(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEMS)
88Q(S) • FAN(S) HOOD(S) WOOOSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESS• •(S) FURNACE(S)
DUCTS GAS PIPE OUTLET(S) HEAT SOURCE: 0 ELECTRIC 0 GAS
PLUMBING
1 BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) 0 ELECTRIC 0 GAS
DRINKING FOUNTAINS) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER.CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
- - - _ :- _ • DISCLAIMER/SIGNATURE BLOCK - - -
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 daim(including costs,expenses,and attorneys'fees incurred in the
investigation and defense of such claim),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 plied the city as a part of this application.
X NAME TITLE: �� DATE: u 2� /i7
•
❑ PROPERTY OWNER 0 APPLICANT CONTRACTOR
FOR OFFICE USE ONLY:
0 NEW 0 ADDITION 0 ALTERATION 0 REPAIR 0 TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION: BUILDING SHELL ONLY? 0 YES 0 NO ' .
COMP PLAN DESIGNATION BASIC PLAN? 0 YES 0 NO
SECTION TOWNSHIP RANGE _ NEW ADDRESS REQUIRED? 0 YES 0 NO
PLATTED LOT? 0 YES 0 NO CHANGE OF USE? 0 YES 0 NO