02-104275r •
�ECENED
4 FRO. CONSTRUCTION PERMIT APPLICATION
JEJ=i�l_ O PPUCATION NUMBER: -
PPUCATION NUMBER: -
C1 Ty OF FEDERAL WAY
PPUCATION NUMBER - -
gpiLDING DEPT.
* *The follo ng Is regdired information — Please print (in ink) or type **
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
PROPERTY INFORMA11ON
SITE ADDRESS: .21 ASSESSOR'S TAX /PARCEL:
..9
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
PROJECT INFORMATION
TYPE OF PROTECT CMIs application): C °UILDING ❑ PLUMBIMG ❑ MECHANICAL ❑ DEMOLITION
Y 'IECTRICAL ❑ ENGINEERING QPIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
PROJECT NAMES 1 VV 1,,� .e, C' D i' �G ✓/ S..
PROPERTY OWNER: : •
CONTRACTOR:
APPLICANT:
r.
00
NAME:
DAYTIME PHONE:
S
2V -1'(M
MAILING STREET ADDRESS: CITY, STATE, ZIP):
EVENING PHONE:
J /0 A 401
St /
( -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
-
E ,S -
(2,01( ) Z u/ - Qv
CONTRACTORS REGiSMTION NUMBER:
EXPIRATION DATE:
(coW of drd required)
fi
I
/09/61/--1
a,- s ' 1. Diu 66. in <s - /'y6p
MAILING ADDRESS (STREET ; CM, STATE, ZIP): EVENING PHONE:
( 204? ) 7-30_ 303-1
RELATIONSHIP TO PROTECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE): ( ?, )2'11 - I f OV
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER APPLICANT ❑ CONTRACTOR
DETAILED BtJILDING INFORMATION 1K
EXISTING USE: EXISTING BUILDING ASSESSED /APPRAISED VALUATION $ -
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: i 2 � 16,0
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
• LAKEHAVEN ❑ HIGHLINE
• LAKEHAVEN ❑ HIGHLINE
❑ TACOMA ❑ PRIVATE (WELL)
❑ PRIVATE (SEPTIC)
. a 0
* *NEW RESIDENTIAL CONSTRUCTION ONLY **
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: S
L I
III PPOJEC I FLOOR AREAS
FLOOR
EXISTING S . FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
COMP PUN DESIGNATION
BASIC PLAN? o YES o NO
AIR HANDLING UNIT(S)
FIRST
GAS LOG(S)
REFRIG. SYSTEM(S)
BBQ(S)
SECOND
WOODSTOVE(S)
BOILER(S)
FIREPLACE INSERT($)
THIRD
_ T MISC.(
COMPRESSOR(S)
FURNACE($)
FOURTH
DUCTS)
GAS PIPE OUTLET(S)
OTHER FLOORS (DESCRIBE)
o ELECTRIC o GAS
PLUMBING
DECK
BATFITUB(S)
LAVATORY(S) T—
GARAGE
HOW MANY FLOORS?
WATER HEATERS)
DISHWASHER(S)
RAIN WATER SYS.
TOTAL:
o ELECTRIC o GAS
DRINKING FOUNTAINS)
SHOWERS)
I cer" under penalty of perjury that the Information furnished by me is true and corral to the best of my knowledge, and
further, that I am authortod 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 attorosys'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 when such claim arises out of the reliance of the city, Including Its officers and employees, upon the accuracy
of the inform supplied to the city as a part of this application.
NAME/TITLE: �"' edi9i►l/ DATE:
OWNE
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION `" o ALTERATION a REPAIR " ❑ TENANT IMPROVEMENT
Indicate number of each type of fbcture
LOT SIZE:
ZONING DESIGNATION:
MECHANICAL
COMP PUN DESIGNATION
BASIC PLAN? o YES o NO
AIR HANDLING UNIT(S)
EVAPORATIVE COOLER(S)
GAS LOG(S)
REFRIG. SYSTEM(S)
BBQ(S)
FAN(S) HOOD(S)
WOODSTOVE(S)
BOILER(S)
FIREPLACE INSERT($)
RANGE(S)
_ T MISC.(
COMPRESSOR(S)
FURNACE($)
DUCTS)
GAS PIPE OUTLET(S)
NEAT SOURCE:
o ELECTRIC o GAS
PLUMBING
BATFITUB(S)
LAVATORY(S) T—
URINAL(S)
WATER HEATERS)
DISHWASHER(S)
RAIN WATER SYS.
VACUUM BREAKER(S)
o ELECTRIC o GAS
DRINKING FOUNTAINS)
SHOWERS)
WASH MACHINE OUTLET
GAS PIPE OUTLET(S)
SINK(S)
WATER CLOSET(S)
_ MISC.
INTERCEPTOR(S)
SUMP(S)
I cer" under penalty of perjury that the Information furnished by me is true and corral to the best of my knowledge, and
further, that I am authortod 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 attorosys'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 when such claim arises out of the reliance of the city, Including Its officers and employees, upon the accuracy
of the inform supplied to the city as a part of this application.
NAME/TITLE: �"' edi9i►l/ DATE:
OWNE
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION `" o ALTERATION a REPAIR " ❑ TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION:
BUILDING SHELL ONLY? ` O YES o NO
COMP PUN DESIGNATION
BASIC PLAN? o YES o NO
SECTION , TOWNSHIP RANGE
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? o YES ❑ NO
CHANGE OF USE? ❑ YES o NO
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063 - 9718.253. 661 -4000 • FAX: 253 - 661 -4129