02-101678 �•� • CONSTRU!ON PERMIT APPLICATION
•.,'r�L APPLICATION NUMBER: - 1. 01 .6-7t- Y
APPLICATION NUMBER: -
AP R 2 3.2002 APPLICATION NUMBER: - -
DERALWA` *The following is required information—Please print I
CITY OF FE EFT (s1►ink) type** .
BILIAQVrnote: Electrical,Fire Prevention Systems and Engineering permits may require a separate application. r
-. %- ■I:PROPERTY INFORMATION .
SITE ADDRESS: 3/00 1L I Ce S ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SU JECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
71/ 6i-of-L,
'� - '-'. 5`R PROJECT INFORMATION _
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ilfMECHANICAL ❑ DEMOLITION
❑ ELECTRICAL El ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTIQN(Provid• detailed d• cription):
•
1 f" 1 /�'.
PROJECT NAME: 11_1
`.- _ >:.'.:■'<:PEOPLE INFORMATION - _ .
PROPERTY OWNER: NAME�: _ DAYTIME PHONE:
w
1,1 {-Gl/ti(,i 6, ( ) -
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: NAM
® DAYTIME PHONE:
F h e Re-c 'e✓ 0f) ( )
MAILING�`'/',A ESS(STREETADJURE -� ITY,STATE,ZIP): ii ��J/,, /�,/ EVENING PHONE: -
CI.T,YjJ�F F�DE�RAL WAY BUSINESS LIC@NSE NUM t' [+M' /4Y` it L ( )
�'3►"'�'►" _ - FAX NUMBER:
( ) -
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) / /
APPLICANT: NAME:
DAYTIME PHONE:
( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
( ) I
RELATIONSHIP TO PROJECT: FAX NUMBER: I
❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
-a `DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: *PROPOSED VALUATION FOR IMPROVEMENTS: $ VV•(O
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES El NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
• •
...NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
•
. ■ PROSECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.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 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 ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
`.•L DISCLAIMER/SIGNATURE BLOCK • .
I certify under penalty of perjury th. 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 daim),which may be made by any person,including the undersigned,and filed against the City of
Federal Way,but only where such daim out of the reliance of the city,induding its officers and employees,upon the accuracy
of the information supplied to the city a art of this application.
NAME/TITLE: DATE:
❑ PROPERTY OWNER ❑l APPLICANT CONTRACTOR
-FOR OFFICE USE ONLY:;:
El NEW El ADDITION ❑ ALTERATION ❑,REPAIR:- 0-TENANT IMPROVEMENT
'CENSUSCODE: LOT SIZE: -
ZONINGDESIGNATION: BUILDING SHELL ONLY? ❑YES ❑ NO
COMP PLAN DESIGNATION BASIC PLAN? ❑ YES El NO
SECTION TOWNSHIP RANGE NEW ADDRESS,REQUIRED? El YES El NO
-PIA- TTED LOT? ❑ YES CI NO CHANGE OF USE? ❑ YES 0.NO
COMMUNITY DEVELOPMENT SERVICES-33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.dtyoffederalway.Com