02-101516 s % e o
Cr.C'r GRECEIVED
F>n� CONSTRUCTION PERMIT APPLICATION
VV E APPLICATION NUMBER: °9-- Q- L ( �p - P
APR 1 0 ZOOZ APPLICATION NUMBER: - -
p APPLICATION NUMBER: - -
**Theclr ggiNWArmation-Please print(ih ink)or type** •
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
->; }> ga:=PROPERTY INFORMATION _
SITE ADDRESS: ___ _Z)__9_,/__9_,./__/, (-_ '� 4it�� S' ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
•:,:::!..1:---•;1':# • -2:':-
,. `'',:■ .PROTECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
' / A
PROJECT NAME: Sri a,—L)eja—,--- ..;:p__
_. > : `lPEOPLE INFORMATION
PROPERTY OWNER: NAME:
`i/?�'' 'Gcr�-� DAYTIME PHONE:( ) -
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
a9/r f _/c_ /y S'.
CONTRACTOR: NAME: / / DAYTIME PHONE:
2 .�rSa�-.- 0,,c? sae.,e_...7 -:„.x.„ ( ) - .
Fe
NG ADDRESS STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
CITY OF FE6ERAL WA/� BUSINESS
NESE NUMBER: FAX NUMBER:
.,-;;;c7-4-3--4.-(21--e-a j.tom/ . v63�3// _ ( ) -
CONTRACTOR'S REGISTRATION/� NUMBER: EXPIRATION DATE:
(copy of card required) / (Z j Pg C •*Q/`�� 6 /
APPLICANT: NAME: f� DAYTIME PHONE:
f3,�,-.c�.i1c e.Y ( )
AILING ADDRESS(STREET`ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
RLI
:IATIONSHIP TO PROJtCI: // '_ ��-�jill C 4":"4"' ( )
FAX NUMBER:
❑ ARCHITECT ❑ TENANT Cl OTHER(DESCRIBE): ( )
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
_. • ■`-DETAILED BUILDING INFORMATION .....:•.::...*:-:
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ 4{*": "
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: Cl YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**NE1K RESIDENTIAL CONSTRUCTION ** /
NUMBER OF BEDROOMS: E'JTIMATED 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 daim(induding costs,expenses,and attorneys'fees incurred in the
investigation and defense of such daim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but only where such daim 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: ►. ! nr_ DATE: ^—4
❑ PROPERTY • NER ❑ APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
NEW. - H ADDITION ❑ ALTERATION ❑ REPAIR' II 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? CI YES ❑ NO
COMMUNITY DEVELOPMENT SERVICES-33530 FIRST WAY SOUTH•PO BOX 9718-FEDERAL WAY,WA 98063-9718-253-661-4000-FAX 253-661-4129
www.cityoftedera Iway.corn