03-1052651212712001 09:01 FAX 2536614129 CITS FE'DEIZALIMAY 2001
WECEIVED 0 FPS
CONSTRUCTION PERMIT APPLICATION
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CITY OF FEDERAL WAY
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.
PROPERTY INFORMATION
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SITE ADDRESS: (9:29 Jr� Jl ASSESSOR'S TAXIPARCEL #: — — - — — — — — — —
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESC'RIP'TION IF LENGTHY):
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INFORMATION
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
ELECTRICAL I7 ENGINEERING - PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
Love/ VonAc -' fipc Atw-i I r oey,
PROJECT NAME: _ f e734LI I�i�Lt (-9k15T1W 3CNQoL - (,,)PjA0k((AL 1LJC -V1 MUCuLRr. '11=4Irc
PEOPLE
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
NAME: r DAYTIME PH
ON
MAILING ADDRESS (STREET ADDRESS; QTY, STATE, ZIP):
56 Huai Vc/a y t,Vfl ' 670 3
NAME:
DAYTIME P
MAILWG ADDRESS (STREETADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
120 5 •31s4 Aae, kk; Sux4( Wfl 9°'12;
(,�06)
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
CONTRACTORS REGISTRATION NUMBER:
f �' (* 2 4 NI L
EXPIRATION DATE:
(copy of card nq*ed)
NAME: DAYTIME PHONE:
'x/ L . C ,/ fi-►�E / '�''Tc`cTl�n� . �7�C (a G ) r yo - '516S
I � r 311"( Gee - dog S4a uj ll -3912 j U0 G) C - 5,463
RELATIONSHIP TO PROJECT: FAX NUMSTR:
❑ ARCHITECT ❑ TENANT Cd�T ' (—�
- - �QTHER (DESCRIBE): � f .. k '1 06 ) W71 - Ei751
CONTACT PERSON FOR THIS PROTECT: ❑ PROPERTY OWNER XUPLICAMT
E.:ISTING USE:
PROPOSED USE: _ A
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
AES
MIfId"Prol ; q6M
enIaiaNG BUILDING ASSESSED /APPRAISED VALUATION
PROPOSED VALUATION FOR IMPROVEMENTS: �/ W9f% h
❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED: ❑ YES ❑ NO
o LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
12/21/2001 09:01 F,," 2536614129 CITY EEDEi12A1.11:1Y 2002
i •
* *NEW RESIDENTIAL CONSTRUCTION ONLY **
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED S . FT.
TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
-HOW-MANY FLOORS?
TOTAL:
FIXTURES
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOGS) REFRIG. SYSTEM(S)
s BBQ(S) FANS) HOOD(S) WOODSTOVE(S)
BOILERS) FIREPLACE INSERTS) RANGE(S) MISC. ( 1
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE, ❑ ELECTRIC Q GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWERS) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINKS) WATER CLOSET(S) MISC. ( )
INTERCEPTORS) SUMP(S)
13LOCK
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 ( includng 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.
NAME /TITLE:
DATE:
0 PROPERTY OWNER [)(APPLICANT Q CONTRACTOR