01-103929 3449lO Pitt_ 64-001 S
art°, G CONSTRUCTION PERMIT APPLICATI•N
EDE.imprillECE!'1/'ED APPLICATION NUMBER: 01 - L(131_L°I_ - '-1r-FP
APPLICATION NUMBERS -
OCT 0 9 2001 - - -
APPLICATION N[�MBER; - - -
*en*fgpiggiD41igggg1 lqd information-Please print(in ink)or type**
r INPreventron Please note: Electrical, re ms and Engineering permits may require a separate application.
• PROPERTY INFORMATION
SITE ADDRESS: h11ol 1 i 97i 't 3%11/41 SWEET ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
• PROJECT INFORMATION
TYPE OF PROJECT(This application): a BUILDING a PLUMBING a MECHANICAL a DEMOLITION
a ELECTRICAL a ENGINEERING WIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): FIRE. ALARAII/AREn OF RESCUE
PROJECT NAME: 1.1M1111bRN NM cams
• PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIMEPHONE:
( ) -
HARING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: NAME: DAYTIME PHONE:
FIB SYSTEMS \117 (KO/)
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
110 W. LAKE RQ SR7KRNE-,\MA 91/12 (S6 )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
- 1 'l C) 090 - 11 (SOOT )V'311 -cm-
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
EL Q EZAII a 5 � L J Oio
APPLICANT: NAME: DAYTIME PHONE:
Zen
MAILING ADDRESS(STREET ;CITY,STATE,ZIP): EVENING PHONE:
( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
a ARCHITECT o TENANT o OTHER(DESCRIBE):
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: a PROPERTY OWNER ❑APPLICANT CONTRACTOR
■ DETAILED BUILDING INFORMATION �'
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ 'Z.1[0
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? a YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:a YES a NO
-
WATER SERVICE PROVIDER: a LAKEHAVEN a HIGHLINE ❑TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER: a LAKEHAVEN ❑HIGHLINE ❑PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• PROJECT 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)
BOILERS) FIREPLACE INSERTS) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: a ELECTRIC ❑GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKERS) ❑ELECTRIC ❑GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTORS) 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 claim(including costs,expenses,and attorneys'fees incurred in the
investigation and defense of such claim),which may be made by any person,induding the undersigned,and flied against the City of
Federal Way,but only where such claim arises out of the reliance of the dty,induding its officers and employees,upon the accuracy
of the information supplied' to the dty as a part of this application.
NAME/TITLE: ` J W DATE:
❑PROPERTY OWNER a APP NT ukCONTRACTOR