02-101632 •
OF _ RE EIVED CONSTRUC I ION PERMIT APPLICATION
�� — APPLICATION NUMBER: o o� - _jQ 1& 2- r/_
APR 1 $ 2002
APPLICATION NUMBER: -
CITY OF FEDERAL WAY APPLICATION NUMBER: - -
ThBefolDoINn DEPT.
**
g is required information-Please print(ih ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
EA;'PROPERTYINFORMATION `_
SITE ADDRESS: .4io9/9 f/9C/, 'C144y/ S' ASSESSOR'S TAX/PARCEL #:
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
"t. .. - ::1';7";.114;PRO3ECTINFORMATION ..
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL Cl DEMOLITION
❑ ELECT' ENGINEERING�FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description r - 'c2
PROJECT NAME: `Jb �COil ( � - k-51ZUMJ
1 X/<:PEOPLE INFORMATION • _
PROPERTY OWNER: NAME: /� DAYTIME PHONE:
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MAIUNG ADDRESS(SI FLEET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: NAME: e /� DAYTIME HONE: e�
,1- p1 O's7 l 7-, 'a! )nn.7
AILING ADDRESS STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER.
t/ 4 -
4, �r�d3 - - - - -
CONTRACTOR'S REGISTRATION NUMBER: r EXPIRATION DATE:
(copy of card required)
APPLICANT: N• DAYTIME PHONE:
MAILING ADDRESS��( REEEE`TADDRESS;CITY,STATE,ZIP): 'may-%/ EVENING PHONE:
RELATIONSHIP TO PROTECT: ,/ �W / 9c=Pezi3
(FAX NUMBER*
❑ ARCHITECT ❑ TENANT El 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 IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ 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 O. **
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:
R. 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) El ELECTRIC ❑ GAS
_ DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.(
INTERCEPTOR(S) SUMP(S)
ii;,DISCLAIMER/SIGNATURE BLOCK .
I certify under penalty of perjury . .t 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 daim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but only where such claim 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: I r�i DATE: 401 �--
❑ PROPERTY • NER ❑ APPLICANT El CONTRACT 11
FOR OFFICE USE ONLY: 1
H NEW__ ❑ ADDITION ❑ ALTERATION ❑ REPAIR CI TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING;DESIGNATION: BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ NO
SECTION ; , TOWNSHIPRANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES' ❑ NO CHANGE OF USE? ❑ YES ❑ NO
COMMUNITY DEVELOPMENT SERVICES-33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718-2S3-G61-4000•FAX 253-661-4129
wwwdtyoffedera lway.com