01-104662 EC
EIVw RUC�ON PERMIT APPLICATION
\>\> FiY �� CONS APPLICATION NUMBER: ( 4 - /c , L-DG'
OEC 0 5 200? APPLICATION NUMBER: _ - _
—
FY OF APPLICATION;NUMBER: _ _ - _ _ _
**The following i f quired information—Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
_ '=PROPERTY INFORMATION
SITE ADDRESS: -3, COr0ASSESSOR'S TAX/PARCEL #: S`
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): /€f(7
-:1 PROJECT INFORMATION =
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ EJNGINEERING$FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): CJG� ; G�c(� "/EN/L'Irl a ( &14
•.1
,✓fes
F„re_ •
PROJECT NAME: Dr, ()c l n1.
e!°
,: ■''PEOPLE INFORMATION
PROPERTY OWNER: NAME:
( L DAYTIME PHONE:
f d 'L / C-t- p/- ! u c r 47.-/ ) -
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
—71-7 1. -T .1f.
CONTRACTOR: NAME:
Ale" - DAYTIME PHONE:
Gle1 ( 0.(2.1 .) 7`�3 -170k1
MAILING ADDRESS(STREET ADDRESS;CHY,
. STATE,,ZIP): , r ` del EVENING PHONE:
-0 -1 L .3 S / 1�'t- L ✓l^r �e.� 0. -X^; s 7 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
06get O�". ` I_-. ---- - )) L) FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION
PIRATION DATE:
(copy of card required)
APPLICANT: NAME: �e DAYTIME PHONE:
_ ( 2� ) ( -7 Li
MAILING ADDRESS(STREET ADDRESS;CITY,SATE,ZIP): EVENING PHONE:
Po Gg x /S6 o-vi CT/ ' ( ) 6of -73g7
RELATIONSHIP TO PROJECT:
FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): (2J ) 76j(
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR ( QL'^',)� e ' i/�`�1 ••
■,;`DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ -1 v
SPRINKLERED BUILDING? 14 YES LI NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION C9Y**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROTECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
. - :.;11 :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.( lb, )
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)
is-II,-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 claim arises out of the reliance of the city,induding its officers and employees,upon the accuracy
of the information sup/41"--)
lied to the city(as a part of this application.
NAME/TITLE: �� �� DATE: ILA-4:1
❑ PROPERTY Ott4(NER APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY l
U NEW CI ADDITION ❑ ALTERATION ❑;REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
,ZONING DESIGNATION: BUILDING SHELL ONLY? _❑ YES ❑ NO
>COMP;PLAN DESIGNATION BASIC PLAN? ❑ YES` ❑ No
SECTION_ - TOWNSHIP RANGE NEW ADDRESS REQUIRED? CI YES ❑ NO
PLATTED-LOT?,. ❑ YES ❑ NO CHANGE'OF USE? ❑ YES ❑ NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-66100-FAX:253{661-4129
IL