03-103202 FP
QT". sa CONSTRUCTION PERMIT APPLICATION
Pr-l= APPLICATION NUMBER: - LQ.6 ac_- _ .1
• APPLICATION NUMBER: - _ : s- -
APPLICATION NUMBER: - -
**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.
SITE ADDRESS: ?./S-40 I /c ASSESSORS TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
A i.RuJCCI IN-ORTIATIO'i
TYPE OP PROJECT(This application): 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION
0 ELECTRICAL o ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): //if 4/ 0.) Ovc /- /-e c Tor> 4-7 ci
Pre)9/-44-,n1 I n J
PROJECT NAME: V j 0 l'Cl Af G)-f O Yl
PROPERTY OWNER: NAPE: DAYTIME PHONE: ,
U�,c l /. / GSvh ( ) -
MAIMAILING (STREET ADORES;QTY,STATE,ZIP):
CONTRACTOR: DAYTIME PHONE:
7,7i'hrti If ( ) - _--°7
( (STREET ADDRESS'CITY,STATE,ZIP): EVENING PHONE:
.) 2 e / 0/G, SER. S, (706 ) 2ei/ -,/(40,
QTY OF FEDERAL WAY BUSINESS NUMBER: FAX NUMBER:
CONTRACTORS REGISTRATION NUMBER: ( ) -
_ / EXPIRATION DATE:
(copy of card required) £ ZAP Se L * t 6 6:4 l G 7I 6'9
APPLICANT: NAME: DAYTIME MORE
fr A !Ai �'. ��' ( ) / - Nie
MAILING ADDRESS
/SS/(STREET ADDRESS; ATE,IIP): EVENING PHONE:
->// /1/ -- ( ) ' .
RBATIONSHIP TO PROJECT: FAX NUMBER:
0 ARCHITECT ❑TENANT vOTHER(DESCRIBE): 4/,/,..-/ ,y ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: 0 PROPERTY OWNER o APPLICANT ❑CONTRACTOR
• ISI IAILIU.) BOILUINL, INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ 4/, ...'
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: 0 YES O NO
WATER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE ❑TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑LAKEHAVEN 0 HIGHLINE o PRIVATE(SEPTIC)
.4._ i •
111
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PRi)JE( J FLOOIs ARIA',
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
■ t Icr t i R l S
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BSQ(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 a GAS
PLUMBING
BATHTUBS) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) a ELECTRIC 0 GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OIrTLET
GAS PIPE OUTLET(S) SINKS) WATER CLOSET(S) MISC.( _ )
INTERCEPTOR(S) SUMP(S)
i:i ,k A1ril It 51(.;NAlI RE f3((I(
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 whkh the permit application Ii made. I
further agree to hold harmless the City of Federal Way as to any claim(including nests,expenses,and attorneys'fees Incurred In the
investigation and defen s of such dales),which may be made by any person,induding the undersigned,and Med 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: 4t i . DATE: Yr V01
❑PROPERTY OWNER ❑APPLICANT 0 CONTRACTOR
FOR OFFICE USE ONLY:
0 NEW 0 ADDITION 0 ALTERATION ❑REPAIR 0 TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION: BUILDING SHELL ONLY? 0 YES ❑NO
COMP PLAN DESIGNATION BASIC PLAN? ❑YES ❑NO
• SECTION TOWNSHIP RANGE 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 98063-9718.253-661-4000•FAX:253-661-4129