04-101318RECEIVED
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CONSTRUCTION PERMIT APPU TION Ll
CITY OF �% A� O $ 200 APPLICATION NUMBER: - -
Federal Way FEDER& WAY PPLICATION NUMBER: _ _ - _ _ _ _ _ _ -
BUILDINGS DEPT. APPI ICATION NUMBER: _
* *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.
SITE ADDRESS:( 40 ZO ► �-t ASSESSOR'S TAXI PARCEL #: _ _ _ _ _ _ - _ _ _ _
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑1 EN_ GINEERIN( & -TARRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): 'n rlec
PROPERTY OWNER:
CONTRACTOR:
NAME: DAYTIME PHONE:
Tfmu L.L. Q-
MAILING ADDRESS (STREET ADDRESS, CITY, STATE, ZIP);
233;
0 e
* *NEW RESIDENTIAL CONSTRUCTION ONLY **
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: S
PROJECT ••• AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE
FIRST
PLATTED LOT? ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
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)
DISHWASHER(S)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTORS)
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S) GAS LOG(S)
FAN(S) HOOD(S)
FIREPLACE INSERTS) RANGE(S)
FURNACES)
GAS PIPE OUTLET(S)
PLUMBING
LAVATORY(S)
RAINWATER SYS.
SHOWER(S)
SINKS)
SUMP(S)
REFRIG.SYSTEM(S)
WOODSTOVE(S)
MISC.( )
HEAT SOURCE: ❑ ELECTRIC ❑ GAS
URINAL(S) WATER HEATER(S)
VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
WASH MACHINE OUTLET
WATER CLOSET(S) MM.( )
DISCLAIM
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, 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: _ �r. I V�l, I C�(�.L J DATE:
❑ PROPERTY OWNER ❑ APPLICANT CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION:
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ 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
www.citvoffedpralway.com