03-104969CrTy of
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CONSTRUCTION PERMIT APPLICATION
PUCATION NUMBER:
s 3 APPLICATION NUMBER:
PPUCATION NUMBER:
�r ta' --- - - - — --
* *The foil jr{ r l{iUFe Wirmation — Please print (in ink) or type **
Please note: Electrical, Fire Prevention Systems and Engineering Y g g permits may require a separate application.
TAX/
(ATTACH SEPARATE IFORI ON IF
TYPE OF PROJECT (This application): BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): ( wS11z -T A N�VJ 1{ T)fZ001NI&T
_ St F e��n� �V F S I DENPE l2 N
PROJECT NAME:
PROPERTY
CONTRACTOR:
APPLICANT:
' , 1f
—c CANT L,
(2 )24A -
NAME:
DAYTIME PHONE:
( 6)Z48
-2/471
MAILING ADDRESS (STREET ADDRESS, QTY, ST ZIP):
5 O u
EVENING PHONE:
�� )298
-Zy7
FAX NNUMM_BER*
G
(TTY OF FEDERAL WAY BUSINESS LICENSE NUM R:
CONTRACTOR'S REGISTRATION NUMBER:
(ODPW card mqufred) �C�t ldl
EXPIRATION DATE:
t)3 /01
/ 03
NAME:
2 (a* )242 -42-o9
RElATI0N5HIP TO PRO) ECi: FAX NUMBER:
❑ ARCHITECT ❑TENANT OTHER ( DESCRIBE): . MptdQ�7¢,� ( )24 Z - Oqq
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT. ❑ CONTRACTOR
EXISTING USE: EXISTING BUILDING ASSESSED /APPRAISED•VALUATION
PPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES ENO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED: ❑ YES ENO
WATER SERVICE PROVIDER: ----e LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: -----U9 LAKEHAVEN ❑ HIGHLINE 11 PRIVATE (SEPTIC)
"NEW RESIDENTIAL CONSTRUCTION
NUMBER OF BEDROOMS:
Y *'
ESTIMATED -L,UNG PRICE:
FLOOR
EXISTING S . FT.
PROPOSED S . FT.
TOTAL
BASEMENT
FIRST
I ,Z �l
SECOND
t2—
1 t( Z
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE i
7
Z
HOW MANY FLOORS?
TOTAL*
2
Indicate number of each type of fixture
MECHANICAL
AIR H NG U ( kVAPORATIVE CILER GAS LOG(S) REFRIG. SYSTEM(S)
Pkt S) ;... ( I RANGE(S) M OODSTOVE(S) 1
R(S) +
S) P O ET S)'"" HEAT SOURCE: ❑ ELECTRIC GAS
PLUMBING
Z BATHTU6(Sj , LAVATORY(S) 1RIMA1(S) WA HEATER,(
1 DISHWASHERS) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC GAS
DRINKING FOUNTAIN(S) • ). SHOWER($) "., i. _ .,'WASH'MACHINE OUTLET
= GAS PIPE OUTLET(S) �_ SINK(S) _3_ WATER CLOSET(S) Misr-
INTERCEPTOR(S) SUMP(S)
I ceMfy under penalty of perjury tih t the information furnisfied 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 &t'al My is 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 effihe city, including its officers and employees, upon the accuracy
Of the information supplied to the city as a part of this application.
:NAME/TITLE: L571Y s •/`l�` ���
.� PROPERTY OWNER . � APPLICANT (L7 CONTRACTOR
ODMMUNITY DEVELOPMENT SERVICES • 33S30 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 •2S3- 661 -4000 • FAX: 253{61 -4129
www.citYofederalway.com