04-103605 .1„:„Itt--,1\iv ! ,
CONSTRUCTI PERMIT APPLICATION
CITY OF 4r...--".........."' ?�� � APPLICATION NUMBER: o 1 to� f
G) Federal Way - - -
APPLICATION NUMBER:
:- � 'v.v`! APPLICATION NUMBER: - - ;
**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.
M PROPERTY INFORMATION ;
SITE ADDRESS: 314002 q Hoy 4- Re, a,ed St,) ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
. E'- I PROJECT INFORMATION -
TYPE OF PROJECT(This application): o BUILDING o PLUMBING ❑ MECHANICAL 0 DEMOLITION
o ELECTRICAL 0 ENGINEERING A FIRE PREVENTION SYSTEM/ \,
PROJECT DESCRIPTION(Provide detailed description): T'L✓-e, Q(ate-yets, .,r//a_?C r 17iti
PROJECT NAME: f2a eYca (AI \ l `e Tcl�'
- .- ` T�A=■ PEOPLE INFORMATION T
PROPERTY OWNER: NAME:�1 i. e. ; DAYTIME PHONE:
Yt01�e 'Di f (.LG c/o /U;cL1Slson 2 . Proo•T.cj ( ) -
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): , 1
Z3 3 3 CO.,'►(l re% 'P+i (C� r K-t�..,..et WA- 5i(03 3 -• 7 3S'? i
CONTRACTOR: NAME: 1 DAYTIME PHONE: i
Me rid i an See uri*4-/ e' E fec-�y; ; (2S3) 63S- -/712;
MAILING ADDRESS(STREET ADDRESS;CITY,STATE.ZIP).. �- EVENING PHONE:
Ta '6 D?c 5 9 7 2 e,�f- WA `/86 Z (2S3 ) 6,V/- 11417"
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
D3 - I 0 g 3 ? - 0 0 i (2$3)(03' -O31
CONTRACTOR'S REGISTRATION NUMBER:
I____ EXPIRATION DATE:\`
(copy of card required) v r i 5_ 0 a-c d l b 3 12-S- "57
APPLICANT: NAME: ! DAYTIME PHONE: !
c►
Meridc .n Sec" . 1 electro( (Z53) <038- 1792 _
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE
Po bp 372-2- (25 3) 637- !?1`'2
RELATIONSHIP TO PROJECT: ; FAX NUMBER:
0 ARCHITECT o TENANT *OTHER(DESCRIBE): ConfiV-&C,#1 r (2S3) 63g -o3?b i
E-MAIL ADDRESS: I
CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER o APPLICANT CONTRACTOR Pi d(an SCc.:
Cd,rN-Ca, • e-
: ■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $/At
]-
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ /c 50
SPRINKLERED BUILDING? o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:o YES o NO
WATER SERVICE PROVIDER: 0 LAKEHAVEN O HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
•**NEW RESIDENTIAL CONSTRUCTION ONLID
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ '
. .: . . . ■ PRO]ECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST 1k 1 (083.,
SECOND
THIRD
FOURTH
OTHER FLOORS.(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
-- "■ FIXTURES. - .
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNITS) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC o GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) o ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
-
■ DISCLAIMER/SIGNATURE BLOCK -
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 daim(induding 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 daim arises out of the reliance of the dty,including its officers and employees,upon the accuracy
of the information supplied to the dty as a partL of this application.�� 9
NAME/TITLE: .7 '_ i_ lr-- - --b ti i IPref AJn. DATE: / C'r° Li
o PROPERTY OWNER 14 APPLICANT p CONTRACTOR
_,FOR,OFFICE USE ONLY r;
- TER N.. : PAI ;� . , TENANTLLIMPROVEMENT'
`,p,.NEW ,:x..31 ❑ADDITION ,..,_ p ALTERATION-=_,�__ ❑;:REPAIR ,�, =fl: :: ,
:CENSUS'CO DE ,
�x:> , .'=-"b., �. .��. .. ��'�.�'�':�� a�'„'z-=�"'" 'LOT SIZE ��-�tV.. F, q`
ZONING DESIGNATION -• :'* -
- - .BUILDING SHELL'�ONLY7�=p YES-,� ❑ NO
COMP PLAN DESIGNATION .- BASIC PLAN? ,.:n YES -=`d NO _`
SECTION •y ,TOWNSHIPF : -RANGE-`,..c.)1,,..1:5.? NEW ADDRESS REQUIRED? , =`'0YES I••.=%oNO
PLATTED LOT? p YES Teo NO itv _ - A CHANGE OF USE? ❑YES 3,fl NO`
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
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