01-104726 • •
«�•� �_ RECEIVED CONSTRUCTION PERMIT APPLICATION
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APPLICATION MASER: ',
c:i i L L*JSAL W,4Y APPLICATION I U 'IBER. . ` ',';','4-''''''''''.2j, :.-. � _''
BUILDING DEPT.
**The following is required information–Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
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• PROPERTY INFORMATION
SITE ADDRESS: /0(,oS(A) atvwforQ , ASSESSOR'S TAX/PARCEL#: LI I S/ 2. 6 - c_)1 /
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
• PROJECT INFORMATION
TYPE OF PROJECT(This application): o BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION
o ELECTRICAL o ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): 1 "O r t .flwC^-C
cr( (\l S C\;cN a,p� c o .T 1 .
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•OJECT NAME- �` A,A 1 F"Q.t‘l Ma
j • PEOPLE INFORMATION
PW)PERTY OWNER: NAME: DAYTIME PHONE:
( )
i MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: N DAYTIME PHONE:
aw 4 /iZ jv63ED c. (1_0(a -1-41 - N ab
MASIIMa&ESS(STREET ADD• ';CITY,STATE,ZIP): EVENING PHONE:
9620 /01` I v FX)O (20U) 7411 - /yam
CITY OF FEDERAL WAY BUSINESS LICENSE NUM R: FAX NUMBER:
&tornE 9 - 1 O5e4 5 - 0a (2qd - ci(- isCTORS REGISTRATION NUMBER: EXPIRATIONDATE:
G ' TL-4u F`if_ 34L 6 /Z• / 3/ /v/
APPLICANT: NAME: DAYTIME PHONE:
�)C alk CrL - (20(.0) 2q ( vis-to
MATIN ADDRESS(STRE ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
RELATIONSHIP TO PROJE : ADILA— FAX NUMBER:
❑ARCHITECT o TENANT OTHER(DESCRIBE):(. (CCCOYL ( "1--- -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER o APPLICANT " ONTRACTOR
• DETAILED BUILDING INFORMATION
ISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ J
&56
SPRINKLERED BUILDING? o ES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:o YES 0 NO
• •
• WATER SERVICE PROVIDER: o LAKEHAVEN o HIGHLINE ❑TACOMA ❑ PRIVATE(WELL)
IIEWER SERVICE PROVIDER: ❑ LAKEHAVEN o HIGHLINE ❑ PRIVATE(SEPTIC)
*NEW RESIDENTIAL CONSTRUCTION ONLY**
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( ►NDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
_,I BOILER(S) ' FIREPLACE INSERT(S) RANGE(S) MISC.( )
1 . COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: o ELECTRIC ❑GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHERS) RAIN WATER SYS. VACUUM BREAKER(S) o ELECTRIC 0 GAS
DRINKING FOUNTAINS) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLETS) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTORS) SUMP(S)
• DISCLAIMER/SIGNATURE BLOCK
I certify under penal of perjury that the information furnished by me is true and correct to the best of my knowledge,and
further,that I am authorize. j. the owner of the above premises to perform the work for which the permit application is made. I
further agree to hold ha the City tif.eral Way as to any daim(induding costs,expenses,and attorneys'fees incurred in the
investigation and defe -e of ch claiich may be made by any person,including the undersigned,and filed against the City of
Federal Way,but oni here uch clai - -s out of the reliance of the city,including its officers and employees,upon the accuracy
of the information .pplied o the ci+ • -la p• • of this application. 12to
NAME/TITLE: .... 10.____ — DATE: JOJ
❑ PROPERTY OWNER rA• •LICANT 0 CONTRACTOR
11111