03-105058CAD ,. CONSTRUCTIQ PERMIT APPLICATION
CITY OF �.� r PPLICATION NUMBER: _
Federal Wa ov 1 2��3 PPLICATION NUMBER: - -
CITY OF FEDERAL WAY ppLICATION NUMBER: -
BUILDING DEPT, — — — — — — — `The following is required information — Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
SITE ADDRESS: U/2� S, - S� ASSESSOR'S TAX /PARCEL #:
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): ❑ BUILDING o PLUMBING o MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL o ENGINEERING.,,FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
PROJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
ram
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NAME:
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i DAYTIME PHONE:
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MAILIN' i G ADDRESS (STREET ADDRESS; CITY, STATE. ZIP): i
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.EVENING PHONE:
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CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: - -
FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER: yy� //�/ //�� % {�/— Q f �/ �� %%
(roPY of card required) G �' f 4 ! vl S cr ! ! 1'-�
1 EXPIRATION DATE:�^ /
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RELATIONSHIP TO PROJECT:
o ARCHITECT ❑ TENANT IkOTHER ( DESCRIBE):
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FAX NUMBER:
E -MAIL ADDRESS:
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CONTACT PERSON FOR THIS PROJECT; ❑PROPERTY OWNER PPLICANT CONTRACTOR
DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED /APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN o HIGHLINE o TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE o PRIVATE (SEPTIC)
AML
* *NEW RESIDENTIAL CONSTRUCTION 1W **
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PR03ECT FLOOR AREAS
FLOOR
EXISTING S . FT.
PROPOSED SO. FT.
TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
AIR HANDLING UNIT(S)
BBQ(S)
BOILER(S)
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)
FAN(S)
FIREPLACEINSERT(S)
FURNACE(S)
GAS PIPE OUTLET(S)
LAVATORY(S)
RAIN WATER SYS.
SHOWER(S)
SINKS)
SUMP(S)
Value of Mechanical Work: $
GAS LOG(S) REFRIG. SYSTEM(S)
HOOD(S) WOODSTOVE(S)
RANGE(S) MM.( )
HEAT SOURCE: o ELECTRIC o GAS
URINAL(S) WATER HEATER(S)
VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
WASH MACHINE OUTLET
WATER CLOSET(S) MISC. ( )
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 city as a part of this application.
DATE: ) I "
❑ PROPERTY OWNER ❑ APPLICANT (J„CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253- 661 -4000 i FAX: 253 -661 -4129
www.citvoffederalway.com