01-103595 CONSTRUL 1 iON PERMIT APPLICATION
I �!� F EIZfiL I A\ifs
�\> FlY ,_, ® APPLICATION NUMBER _ Q� ---
`t/OI NUMBER _ -
SFP 13 ?0,9 i APPLICATION NUMBER: _ _ _ _ _
**TheOblbteriinu}g t-e jr 4 formation-Please print(in ink)or type**
BUILDING D PT.
Please note: Electrical,Fire Prevention ystems and Engineering permits may require a separate application.
0 PROPERTY INFORMATION
SITE ADDRESS: 341'6,1 t7 P t 1 f-IG, -1{Vr( S, ASSESSOR'S TAX/PARCEL#: Z o Z l d g - a S. S'
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
r
1.1 PROJECT INFORMATION
TYPE OF PROJECT(This application): 0 BUILDING 0 PLUMBING ❑ MECHANICAL 0 DEMOLITION
0 ELECTRICAL 0 ENGINEERINGFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): 1i " ``L 4 �i QF Li L\E_ + 1 4 �0.4 .
LI LES (:q2o4-1 VAQ1 T -ca �LA.)Ete 1�. .00k (-Olt-xi
PROJECT NAME: PeAkariitn2.0 t 1Ji--1 S 4 rrc
li, PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
F \PFV . --\ 1t rC-rEJ S (2s3)83e -oioz
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
3"1010 R TC-A e• #}4- i 5 `T 3
CONTRACTOR: NAME: DAYTIME PHONE:
QAS 6 . l'��ls- -ag-S (2. )f53`3 -S'ZiPVI
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
1-33IS- N_ MOIJRZoE' ( ) -
Q1 Y OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
20 - Q 1 - 1 Q 0 4 41 le - 0 0-8L (253) 83S---S'7`1
CONTRACTORS REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card r F o R A S 6 G Q lQ l2 D E / 23 /a Z
APPLICANT: NAME: DAYTIME PHONE:
t- V A-T .iu -IIE1-3TS (ZS3 )3S - X Z
1 MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
-g{oIo FA4AFV... iivsi '5 , �C.F'-7 w'A. "Ic3 ( ) -
RELATIONSHIP TO PROJECT: FAX NUMBER
0 ARCHITECT 0 TENANT EroTHER(DESCRIBE): * 1 L ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: 0 PROPERTY OWNER 0 APPLICANT 0 CONTRACTOR
'4 DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
!f PROPOSED USE: *'ROPOSED VALUATION FOR IMPROVEMENTS: $ 2.000
I
iSPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES 0 NO
WATER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION O. -**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PRO]ECT FLOOR AREAS
FLOOR EXISTING SQ.FT, PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
■ FIXTURES
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(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: 0 ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) 0 ELECTRIC 0 GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
F1 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(induding costs,expenses,and attorneys'fees incurred in the
Investigation 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 employees,upon the accuracy
of the information supplied
to the city as a part of this application.
NAME/TITLE: DATE: -- i3 ` d)
❑ PROPERTY OWNER 0 APPLICANT CONTRACTOR
•
tFOltOFFICEIUSE-40NLYid
o NEW £ ❑:ADDITION ❑>ALTERATION . ;REPAIR F ❑TENANT IMPROVEMENT. '`
.ZONLNG `ESIGNATIO
- N � ., BUILDING SHELL ONLY? ❑YES; ❑ NO
AOhIQ*PL y0:0IGNATION - BASIC PLAN?y 4 "YES ❑ NO
I ❑ YES q.NO
�ECTiON�� � TOWNSHIP�,,� RANGE NEW ADDRESS REQUIRED?,
PLATTED'LOT? - ,0 AYES i ❑ NO CHANGE OF_USE? ❑YES, ,' ❑ NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX.'253-661-4129