01-10273705/31/2001 12:06 FAX 2536614129 CITY FEDERALWAY IM 002/004
CONSTRUCTION PERMIT APPLICATION
ESL- PPLICA -110N NUMBER:
U 1 I -` APPLICATION NUMBER:
1 it PPLICATION NUMBER:
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* *rhe� r 7rt 6rmation — Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
PROPERTY
X SITE ADDR>RSS: J U 'DSO 39-01- ASSESSOR'S TAXIPARCEL #i: ` _ _ - _ _ — _
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): O BUILDING ❑-PLUMBING ❑ MECHANI44(4L 0 RrEMOLITION -
J$ ELfCYRICAL ❑ ENGINEERING ,..
PROJECT DESCRIPTION (Provide detailed description): A
PR03ECT NAME:
PROPERTY OWNER:
CONTRACTOR:
APPLICANT.
E
NAMr: t DAYTIME PHONC:
MAfZ (5f-A 5 aia f �r ( ) -
MAILING ADDRESS (STREET ACORI?$ ; CIrY. STATE, P):
) � � � ���
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DAYTIME PIiDNG: �
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MA(UN ADDRESS (SIREtT RF-W; CM,,�S+/TATZ. ZIP?
ENING PHONe.
CITY OF FEDCRAk WAY OUSINESS CENSE NUMQCR:
F Numi0 R:
CONTRACTORS R,4 RA ON NUMBER:
EXPI MON DATE:
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(coos or Bard rgqumd) �; ^ ,D
NAM
DAYTIME PHONE:
Q
( ) -
MAILING ADORESS (SIRE ADORC55; CITY. STATE, ZIP):
EVENING PHONE:
( )
RELATION IP PRojecr:
FAX NUMBER:
❑ ARCHITECT ❑ TENANT O OTHER ( DESCRIBE):
( )
EMAIL ADDRESS:
FOR THIS PROJECT: ❑PROPERTY OWNER O APPLICANT
O CONTRACTOR
i
CONTACT PERSON
i
• • • INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED /APPRAISED VALUATION
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS:
SPRINKLERED BUILDING? ❑ YC'S ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER - 0 LAKEHAVEN 0 HIGHLINE ❑ PRIVATE (SEPTIC)
i
A
05/31/2001 12:07 FAX 25366141 CITY FEDERALWAY
•
• "NEW RESIDENTIAL CONSTRUCTION ONLY ""
NUMBER OF 13EDROOMS_
ESTIMATED SELLING PRICE.
■ . PROJECT FLOOR AREAS
(M 003/004
FLOOR
EXISTING S . FT.
PROPOSED S . FT.
TOTAL _
BASEMENT
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
AIR HANDLING UNITS)
FIRST
GAS LOG(S)
REFRIG. SYSTEM(S)
BBQ(S)
SECOND
HOOD(S)
WOORSTOVE(S)
BOILERS)
THIRD
RANGE(S)
MISC. ( )
COMPRESSOR(S)
FOURTH
DUCT(S)
OTHER FLOORS (DESCRIBE)
HEAT SOURCE.
O ELECTRIC ❑GAS
DECK
BATHTUBS)
GARAGE
HOW MANY FLOORS?
URINALS)
WATER HEATER(S)
DISHWASHER($)
TOTAL:
VACUUM BREAKFR(S)
❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S)
n16CtAIME11 ICTGNATURE BLC
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and
further, that I am authorized by the owner of the above premises to perform the work for which the permit application is made. I
further agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in the
investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the City of
Federal Way, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy
of the information supplied to the
ciityyasapart of this application.
NAMEITITLE:
❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADOITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
Indicate number of each type of fixture
LOT SIZE:
ZONING DESIGNATION:
MECHANICAL
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
AIR HANDLING UNITS)
EVAPORATIVE COOLER(S)
GAS LOG(S)
REFRIG. SYSTEM(S)
BBQ(S)
FAN(S)
HOOD(S)
WOORSTOVE(S)
BOILERS)
FIREPLACE INSERT(S)
RANGE(S)
MISC. ( )
COMPRESSOR(S)
FURNACES)
DUCT(S)
GAS PIPE OUTLETS)
HEAT SOURCE.
O ELECTRIC ❑GAS
PLUMBING
BATHTUBS)
LAVATORY(S)
URINALS)
WATER HEATER(S)
DISHWASHER($)
RAINWATER SYS.
VACUUM BREAKFR(S)
❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S)
SHOWER(S)
WASH MACHINE OUTLET
GAS PIPE OUTLET(S)
SINK(S)
WATVFt CLOSET(S)
MISC. ( )
INTERCEPTORS)
SUMP(S)
n16CtAIME11 ICTGNATURE BLC
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
ciityyasapart of this application.
NAMEITITLE:
❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADOITION ❑ 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 RE UIRED? 0 YES ❑ NO
PLATTED LOTS ❑ YES O NO
CHANGE OF USE? ❑ YES ❑ NO
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