01-103564CONSTRUOi ION PERMIT APPLICATION
APPLICATION NUMBER: 01
APPLICATION NUMBER: - -
APPLICATION NUMBER:
**T446A,'v i � S required,ihformation -- Please print (in ink) or type**
Cr�FT.
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
■ PROPERTY INFORMATION
SITE ADDRESS: 79 3 Fa0 W6YEOIK OSCZ Lj�Y' ASSESSOR'S TAXIPARCEL #-. _ _ _ _ — _ - —
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
J. �: =� ; _' . 1 PR03ECT INFORMATION
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ EHGINEERZN�FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): TE11QOr [ K P f d V F-MEiVi ADD 1 T 1 6 r %L jrt R-E �L"
SY 5 ►CEJA CtlVGVLt,&5 l Qr-LJDt ns()- COM IDLE [`L SM011Z
Co VL-f-- &S OF ALL RWAS,
PROJECT NAME: ERS-T CA+'APvS COV-POIL&IT. P-An-r- 17i RLDC- i') WF-Yr M 4-VSEfl-.
E-PEOPLE INFORMATION
PROPERTY OWNER:
CONTRACTOR:
F.0 juacer.11eW
NAME: � DAYTIME PHONE: —
}
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
NAME:
DAYTIME PHONE:
(360) 47 - 33O F
MAILING ADD PISS (STREET ADDRESS; CITY, STATE, TIP):
q��63
EVENING PHONE:
( 9CO) 4a� - okn 30
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
do -
—
l o t 7 14 7
— — — —
6 o
—
FAX NUMBER:
( 36a ) 4s7 - 561X
CONTRACTORS REGISTRATION NUMBER.
rr
D
EXPIRATION DATE:
1 1
[cvvr of card required] f L D
E 17 g
NAME: DAYTIME PHONE;
KaG-t---YL ) 36VR1z' (36o) 74 3
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING P
HONE'
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE)- ( } -
E-MAIL ADDRESS:
CONTACT PERSON FORTHIS PROJECT: ❑ PROPERTYOWNER ❑ APPLICANT ❑ CONTRACTOR
S '.DE' -AILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED [APPRAISE D VALUATION
PROPOSED USE:
PROPOSED VALUATION FOR IMPROVEMENTS: $ 2-2 T�
SPRINKLERED BUILDING? �d YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION O- !**
NUMBER OF BEDROOMS:
ESTIMATED SELLING PRICE:
■ PROJECT FLOOR AREAS
FLOOR
_ EXISTING 5 . FT.
PROPOSED S , FT.
TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
AIR HANDLING UNIT(S)
BBQ(S)
BOILERS)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHERS)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTORS)
- ■ -FIXTURES
Indicate ,member of. each type cf fixture
MECHANICAL
EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
FAN(S) HOOD(S) WOODSTOVE(S)
FIREPLACE INSERT(S) RANGE(S) MISC. [ }
FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
LAVATORY(S) URINAL(S) WATER HEATER(S)
RAIN WATER SYS. VACUUM BREAKER(S) ElELECTRIC ❑ GAS
SHOWER(S) WASH MACHINE OUTLET
SINK(S) WATER CLOSET(S) MISC. }
SUMP(S)
!7T�i'I.nilYtF{t►Crr'lIfII7'[t1lX pll C!
I certify under penalty of perjury that the information fumished by me is true and correct to the best of my knowledge, and
further, that I am authorized by the owner of tile 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 (inctuding 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 supplied to the city as a part of this application.
NAME/TITLE: ` "'— DATE: Se•rT— t t.20 9
r -
❑ PROPERTY OWNER ❑ APPLICANT CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION
CENSUS CODE:
❑,REPAIR ❑ TENANT IM PROVEM ENT
LOT SIZE;
ZONING DESIGNATION :
BUILDING SHELL ONLY? _ El YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES, ❑ NO
SECTION _TOWNSHIP RANGE
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT7 ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
C[7MMUNI- Y (7EVELOPMENT SERVICES • 33S30 FIRST WAY SOUTH • PO BOX 9718 • FEDERALWAY, WA 98063-3718 • 253-6614000 • FAX: 2S3-661-4129