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411141% CONSTRUCTION PERMIT APPLICATION
CITY OP Federal Way a a i, � a# ��
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**The followinEpg isErequired 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..00 I 6. '3 A-Y t,_ ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): ,:J� RC _.(7''Q5
• PROJECT INFORMATION
TYPE OF PROJECT(This application): 0 BUILDING ❑ PLUMBING o MECHANICAL o DEMOLITION
❑ ELECTRICAL o ENGINEERING XF,IRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): MD(`n OA)5 m F(EF joi-(_Prey✓L c ,5?
PROJECT NAME: '(T r.063) .55( V F" 'F. f . t{ FC.ooe
• PROJECT INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
MAILINGfla
-
RESS(STREET ADDRESS;CITY,STATE,ZIP): )
.910 ,pox R44f49'
CONTRACTOR: NAME: DAYTIME PHONE:
n p.�P.� (las-) V3 - 9350
MAILI G ADD S(STREET ADDRESS;CITY, ATE,ZIP): EVENING PHONE:
6991 (4(4 T A-va _ _ su rrF, II MOK1 c.�-F.n I 143A- i ra' - - ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
- - (%sfia fo -6--I
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) / /
APPLICANT: NAME: DAYTIME PHONE:
P swop Aul.eifvti ti / Kph ell t,&) (qz5 ) 697- - au6
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
/too ONSHIP TO PROJwoao Y ALL. bum,is are.i Gyt,uvLaon i LAI ri- q 6036
F(
)
LATIECT: FAX NUMBER:
❑ARCHITECT o TENANT o OTHER(DESCRIBE): (lzb—)6?7 -09
ADDRESS:
CONTACT PERSON FOR.THIS PROJECT: o PROPERTY OWNER *APPLICANT 0 CONTRACTOR JreftegwSA.sis 4k95tCAry
• PROJECT INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ �j/ �j
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ /O� c�/- C�
SPRINKLERED BUILDING? )(YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: o YES 0 NO
WATER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: o LAKEHAVEN o HIGHLINE o PRIVATE(SEPTIC)
NEW RESIDENTIAL CONSTRUCTION•Y** I
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• PROJECT 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)
■ 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 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$LXRclaim arises out of the reliance of the city,including its officers and employees,upon the accuracy
of the information supplied to the ci s a part of his applica ion.
NAME/TITLE: �'" �/' -"""•;"://
,%/ DATE: 07•
o PROPERTY OWNER o APPLICANT o CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ADDITION o 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? ` ❑;YES ❑ NO
PLATTED LOT? ❑YES ❑ NO CHANGE OF USE? 0 YES o NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.cityoffederalway.com