02-1052770
m RECEIVED
vv
NOV 2 2 2002
I ,
40
CONSTRUCTION PERMIT APPLICATION
PPLICATIOWNUMBER: lJ Z - 1 d 5 Z? -7
PPLICATION' NUMBER: -
CITY PPLICATION NUMBER: - -
;sJ)9/uired information — Please print (in ink) or type **
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Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
SITE ADDRESS:,-I 5 - 3 `f'? (001 -606 6. U&NDASSESSOR'S TAX /PARCEL #: -,7? �! � /
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
W DeLP U[SION. 5o �E '9Lb
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEEERING V FIRE PREVENTION SYSTEM , l
PROJECT DESCRIPTION (Provide detailed description): J) () ( ') E0 L.-) G (? s U`P P L� 4- ay
(,OIJ yo m-ftfae 0 EV ( CEs Fop T.T. Ft .c-Ae rtj -Z 44'
..W MR I d �7
PROPERTY OWNER:
CONTRACTOR:
NAME: DAYTIME PHONE:
6aor-oP_9 Po(0)58 -
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
30.1 0 . 'JA 2910-'7
NAME:
a-5 t � ft(Ae t PLC
DAYTIME PHONE:
(�{aS) /1,&
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
of
Wrt 187
EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: I
-20 • o'Q - /00,Y-7,p - 0a:
FAX NUMBER:
(425) 617 -,9t
CONTRACTOR'S REGISTRATION NUMBER:
I EXPIRATION DATE:
(copy of card required)
APPLICANT'
NAME:
s .4s arm S,4,1, Sl PDL,6
DAYTIME PHONE:
c ) -
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, P):
EVENING PHONE:
( )
RELATIONSHIP TO PROJECT:
FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE):
E -MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
EXISTING USE:
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
EXISTING BUILDING ASSESSED /APPRAISED VALUATION $
PROPOSED VALUATION FOR IMPROVEMENTS: $
• YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED: ❑ YES ❑ NO
• LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
* *NEW RESIDENTIAL CONSTRUCTION ONLY **
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
FLOOR
EXISTING S . FT.
PROPOSED S . FT.
TOTAL
BASEMENT
COMP PLAN DESIGNATION
BASIC PLAN? o?YES ❑ NO
SECTION TOWNSHIP ' ' RANGE
FIRST
PLATTED LOT? ; o YES o NO
CHANGE OF USE? o YES o NO
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
AIR HANDLING UNIT(S)
BBQ(S)
BOILERS)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHER(S)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTORS)
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
FAN(S) HOOD(S) WOODSTOVE(S)
FIREPLACEINSERT(S) RANGE(S) MISC.f )
FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: o ELECTRIC o GAS
PLUMBING
LAVATORY(S)
RAINWATER SYS.
SHOWER(S)
SINK(S)
SUMP(S)
URINAL(S)
VACUUM BREAKER(S)
WASH MACHINE OUTLET
WATER CLOSET(S)
WATER HEATER(S)
o ELECTRIC o GAS
MM.(
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 (Sty 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 supplie"o the city as a part of this application.
�5101RFIIIPP DATE: 1.
o PROPERTY OWNER o APPLICANT ❑ CONTRACTOR
o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE: ,
ZONING DESIGNATION:
BUILDING SHELL ONLY? o YES o NO
COMP PLAN DESIGNATION
BASIC PLAN? o?YES ❑ NO
SECTION TOWNSHIP ' ' RANGE
NEW ADDRESS REQUIRED? ❑ YES o NO
PLATTED LOT? ; o YES o NO
CHANGE OF USE? o 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
www.ciWyaffederalway.com