04-101108 GT.oF G CONSTRUCTION PERMIT APPLICATION
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--�— EDEIZFit MAR 2 6 2004 APPLICATION NUMBER: OH. - 10 I L 01(-00
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APPLICATION NUMBER: - -
CITY OF FEDERAL WAY
BUILDING DEPT. 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.
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• PROPERTY INFORMATION
SITE ADDRESS: 2 1.- `, { t '(�k AA,ce, < ASSESSOR'S TAX/PARCEL#: -
LEGAL 0 ESC•IPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
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■ PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING o MECHANICAL ❑ DEMOLITION
(ELECTRICAL ❑ ENGINEERING IRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): t '4 - 0,1ar 111/1 �-1-eA/t/LJ
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PROJECT NAME: l C,LCV- Q i C0_, 1' l' it) 61 Inc it .j C Id 1 I ( c
• PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
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MAILING ADDRES (STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: I NAME: - DAYTIME PHONE:
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MAILING A DRESS(STREET ADD SS;CIT
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,STATE,ZI EVENING PHONE: 2.:--10
CITY OF FE L WAY BU NES LICENSE NUMBER: / ,/ / ' cup (NUMBER:
J q - q1 I ? _kU5Cit - 03 (zc(,) 3'� L- CLQ25�
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) ( L 6t, d s S 23 3 L S 09 /0( / 01{-
APPLICANT: NAME: I�^`CC DAYTIME
,PHONE: 7
MAILING ADDRESSSTi CITY,STATE,ZIP)4 I^ iEV G PHONE: 7 `C(L
RELATIONSHIPti
tb PROJECT: �/Gt t S v i2 G` W�/ 3 - FAX NUMBER:
❑ ARCHITECT ❑ TENANT ,J OTHER(DESCRIBE): (on frac- v (me).. --1 I - ql q25�
E-MAIL ADDRESS: t
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: $
SPRINKLERED BUILDING? ❑ YES ❑ 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 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 HANDLING EVAPORATIVE GAS LOG(S) REFRIG.SYSTEM(S)
UNIT(S) COOLER(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 VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
SYS.
DRINKING SHOWER(S) WASH MACHINE
FOUNTAIN(S) OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
I 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 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. c
NAME/TITLE: Ile
A . 1 i 1 , 41 INSIA/ ' Q/( TE: 3125
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❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION : BUILDING SHELL ONLY? ❑ YES o NO
COMP PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? o YES ❑ NO
PLATTED LOT? o YES ❑ NO CHANGE OF USE? ❑ YES o NO