04-100848CONSTRU N PERMIT APPLICATION
CITY OF �� MAR I 1 200 PPLICATION NUMBER: _ _ - L Q Q _ -
Fe d e ra I Way PPLICATION NUMBER:
CITY OF FEDERAL WAY
BUILDING DEPT. ppLICATION 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.
l
PROPERTY INFORMATION
(�
SITE ADDRESS: 4 z l oQ �( !(J ASSESSOR'S TAX /PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PR07ECT INFORMATION
TYPE OF PROJECT (This application): o BUILDING o PLUMBING ❑ MECHANICAL o DEMOLITION
ELECTRICAL ❑ ENGINEERINGPqIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
Lod( V9 fl OF W RWKM aggj Pe Pt AV5
PROJECT NAME:
-tt
S PEOPLE INFORMATION.: -
PROPERTY OWNER: NAME:
�rsG I
CONTRACTOR:
MAILING
H
� 0%ff FIRE PROTECTION, INC.
MAILING ADDRESS (STREET ADDRESS; CITY. STATE. ZIP): 1LU40 .4101 AYC Mr.
,
SEATTLE, WA 98125
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:O 0 - t)
CONTRACTOR'S REGISTRATION NUMBER: 1 l
(CDPY of lard required) r
APPLICANT: I NAME:
=I` 0%! FIRE PROTECTION, INC.
DAYTIME PHONE:
(10E
EVENING PHONE:
(zo` ) VV0 3
0 FAX NUMBER:
V7 Off
L I EXPIRATI N DATE:
DAYTIME PHONE:
(mil) Wo - 5 ?63
I MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): • "'�" �'� ' • " - "'- i ^ IN , -
SEATTLE WA 98125 I EVENING PHONE:
(1-06 yy4 5W3
RELATIONSHIP TO PRO)ECT: r� FAX NUMBER:
❑ ARCHITECT ❑TENANT OTHER ( DESCRIBE): 6C!NI �C Cif (�Q6) qI - 20
E-MAIL ADDRESS:
A� - -�
(I /Ic{S�rir .
CONTACT PERSON FOR THIS PROJECT: ❑PROPERTY OWNER ❑APPLICANT ONTRACTOR % ul(„1'1 �Nli (Oki!
DETAILED BUILDING INFORMATION
EXISTING USE: Q EXISTING BUILDING ASSESSED/ APPRAISED VALUATION $
PROPOSED USE: IJ PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? Pk"YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED:;6ES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN o HIGHLINE o TACOMA o PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
* *NEW RESIDENTIAL CONSTRUCTION ONU
NUMBER OF BEDROOMS:
ESTIMATED SELLING PRICE:
FLOOR
EXISTING S . FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
AIR HANDLING UNITS)
BBQ(S)
BOILERS)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHERS)
FIXTURES
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S)
FAN(S)
FIREPLACEINSERT(S)
FURNACE(S)
GAS PIPE OUTLET(S)
PLUMBING
LAVATORY(S)
RAIN WATER SYS.
DRINKING FOUNTAIN(S) SHOWER(S)
GAS PIPE OUTLET(S) SINKS)
INTERCEPTORS) SUMP(S)
Value of Mechanical Work:
GAS LOG(S) REFRIG. SYSTEM(S)
HOOD(S) WOODSTOVE(S)
RANGE(S) MISC. (
HEAT SOURCE: o ELECTRIC o GAS
URINAL(S) WATER HEATER(S)
VACUUM BREAKER(S) 0 ELECTRIC o GAS
WASH MACHINE OUTLET
WATER CLOSET(S) MISC.
]TSCLOTMFR /STGNATHRF RLC
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 F&be reliance of the city, including its officers and employees, upon the accuracy
of the Information supplied to th as 'at application.
�aM ow'�l 7 rQ Q�
NAM E /TITLE: DATE:
❑ PROPERTY OWNE APPLICANT .CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063 -9718 • 253{661 -4000 • FAX: 253 - 661 -4129
www.cityoffederalway.com