03-103317f 0
a RECEIVED CONSTRUCTION PERMIT APPLICATION
PPLICATION NUMBER: - -
AUG 1 4 2003 Fouanm NUMBER: - -
CITY OF FEDERAL WAY PpI.ICATION NUMBER:_
* *The fbIiAv iiq0li Qg9&dinformation - Please print (in Ink) or type** �1 �
Please note: EhKtrkd, Fin prevention Systems and Engineering permits may require a separate application. l
SITE ADDRESS: PL < W ASSESSOR'S TAX /PARCEL *: "( Q L d Q Q Q z Q
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE Of PROJECT (nU application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING ARE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): -lN S><t �� �11a(v.31li / T.�L S✓d // d ,%ii On Sl,hllrer
CONTRACTOR:
APPLICANT:
NAME:
DAYTDIE PHONE:
MAAAiG STREET , 5TA7F, ZI):
an OF FEDERAL WAY euslNESS Nut: -
CDNTRACIOn REGSTRATION NUMBER:
G
TION DATE:
0I /6)p /0
(a" d -6 �)
❑ ARCHITECT ❑ TENANT ❑ OTHER (
2A/ -
6 -
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER NXPPLICANT ❑ CONTRACTOR I
EXISTING USE: EXISTING BUILDING ASSESSED /APPRAISED VALUATION
PROPOSED USE: -I Aj /1 f - &qA PROPOSED VALUATION FOR IMPROVEMENTS: ;
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
0 0
* *NEW RESIDENTIAL CONSTRUCTION ONLY **
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: ;
FLOOR
EXISTING S . FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
'
BASIC PLAN? ❑ YES ❑ NO
AIR HANDLING UNIT(S)
FIRST
GAS LOG(S)
REFRIG. SYSTEMS)
saws)
SECOND
HOOD(S)
WOODSTOVE(s)
DOURO)
THIRD
RANGE(S)
_ MISC. ( 1
COMPRESSOR(S)
FOURTH
bUCT(S)
OTHER FLOORS (DESCRIBE)
HEAT SOURCE:
❑ ELECTRIC 4 GAS
�
.
DECK
BATHTUB(S)
GARAGE
HOW MANY FLOORS?
URINALS)
WATER HEATER(°S)
DISHWASHER(S)
TOTAL:
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S)
0/1
I car" under p«osih of podury that the Information furnbW by me Is true and correct to the best of my knowledge, sirrd
further, that I am authorked by the owner of the above promises to perform the work for which the permit appNption Is mode. I
further agree to hohi harmless the City of Federal way as to any daim (induding costs, expense* and attarno `few incurred In the
Investigation and defense of such dahn), which mq be made by any person, induding the undwiftned, and fled against the City of
Federal Way, but only whom such dahb orb" out of the rolanco of the city, including Its offiosrs and empiayea* upon the accuracy
of the kNonnstbn suppled to the city as s part of this application.
NAME /TITLE: �VJ4, DATE:
❑ PROPERTY OWNER IVPPL.ICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADOMON O ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
Indicate number of each typo of fixture
LOT SIZE:
ZONING DESIGNATION:
MECHANICAL
'
BASIC PLAN? ❑ YES ❑ NO
AIR HANDLING UNIT(S)
EVAPORATIVE CDOLER(S)
GAS LOG(S)
REFRIG. SYSTEMS)
saws)
FAN(S)
HOOD(S)
WOODSTOVE(s)
DOURO)
FIREPLACE INSERT(S)
RANGE(S)
_ MISC. ( 1
COMPRESSOR(S)
FtiRNACE(S)
bUCT(S)
41AS PIPE OUTLET(S)
HEAT SOURCE:
❑ ELECTRIC 4 GAS
�
.
PLUMBING
BATHTUB(S)
LAVATORY($)
URINALS)
WATER HEATER(°S)
DISHWASHER(S)
RAIN WATER BY&
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S)
SHOWER(S)
WASH MACHINE OUTLET
GAS PIPE OUTLETS)
SINK(S)
WATER CLOSET(S)
MISC. (�;� 1
INTERCEPTOR(S)
BUNKS)
0/1
I car" under p«osih of podury that the Information furnbW by me Is true and correct to the best of my knowledge, sirrd
further, that I am authorked by the owner of the above promises to perform the work for which the permit appNption Is mode. I
further agree to hohi harmless the City of Federal way as to any daim (induding costs, expense* and attarno `few incurred In the
Investigation and defense of such dahn), which mq be made by any person, induding the undwiftned, and fled against the City of
Federal Way, but only whom such dahb orb" out of the rolanco of the city, including Its offiosrs and empiayea* upon the accuracy
of the kNonnstbn suppled to the city as s part of this application.
NAME /TITLE: �VJ4, DATE:
❑ PROPERTY OWNER IVPPL.ICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADOMON O ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION:
BUILDING SHELL ONLY? a YES ❑ NO
COMB PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO
I CHANGE OF USE? ❑ YES ❑ NO
COMMUNITY DEVELOPMENT SERVICES • 33S30 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063 - 9718.253- 661 -40W • FAX: 253 - 661 -4129