Loading...
03-104654 OECEIVED CONS I RUCION PERMIT APPLICATION FP CITY OF �..� APPLICATION NUMBER: - i odc,5Q _DO Federal Way OCT I 0 200i APPLICATION NUMBER: - APPLICATION NUMBER: - - CITY OF FEDER Ay *"The follo1.$tJigli®ngept5 rrnation–Please print(in ink)or type** Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application. = R PROPERTY INFORMATION - -- SITE SITE ADDRESS: !4/ /' TX/ ASSESSOR'S TAX/PARCEL #: f ' bi( (,71 - I 0 96 LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): -1 ' .. . - U PR03ECT INFORMATION TYPE OF PROJECT(This application): 0 BUILDING o PLUMBING ,MgCHAN CAL ❑ DEMOLITION 0 ELECTRICAL o ENGINEE•ING y "�tRE P! ENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description): l jl :5 4'�/ - / — 471;frt •�(4. ' L4)a ie C-velee iiCh ! ,i-/o PROJECT NAME: ` e-Ai C P,& tr/t/ . ;:I PEOPLE INFORMATION _: PROPERTY OWNER: NAME: fj Seff r /A DAYTIME PHONE: MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): % / I CONTRACTOR: NAME: i ItitLieiZI DA E PHONEitzve MAILING ADDRESS( EET ADDRESS;CITY,STA .P): �. EVENING ONff b0 17<?° /e, ) CITY OF FEDERAL WAY:. ESS LICENSE iMBER: FAX UMBER: 20 - d� (eli61(-c / &) - -zlef CONTRACTORS REGISTRATION NUMBER: ` 1 EXPIRATION DATE: (copy required) ) /Z 7 0 / / d:,- APPLICANT: NAME: �� DAYTIME PHONE: ( ) MAILING ADDRESS(SW ET ADDRESS;CITY,STATE,ZIP): EVENING PHONE: � ( 1 - RELATIONSHIP TO PROJECT: / i I FAX NUMBER: o ARCHITECT o TENANT BOTHER ( DESCRIBE) � i ( ) _ E-MAIL ADDRESS: CONTACT PERSON FOR THIS PROJECT: u PROPERTY OWNER u APPLICANT !1 CONTRACTOR •1111 DETAILED'BUILDING INFORMATION . , EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ ✓©�COO SPRINKLERED BUILDING? BYES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES 0 NO WATER SERVICE PROVIDER: ❑ LAKEHAVEN o HIGHLINE o TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER: o LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC) MEM s • **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 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: o ELECTRIC ❑ GAS PLUMBING BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S) DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC o 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 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,induding its officers and employees,upon the accuracy of the information supplie. to the city pa of is a cation. Y NAME/TITLE: /` DATE: te)///9/%d o PROPERTY OWNER ❑ APPLICANT ❑CONTRACTOR FOR OFFICE USE ONLY: n'NEW.. r❑'ADDITION - . o ALTERATION'?. ,".1. ❑';REPAIR o TENANT IMPROVEMENT - CENSUSCODE. LOT SIZE: :ZONING DESIGNATION , BUILDING SHELL ONLY?-%'o YES "`.=❑ NO -COMP PLAN DESIGNATION BASIC PLAN? ., "o YES = ❑"NO SECTION%; , . -, TOWNSHIP RANGE 'NEWADDRESS REQUIRED? ❑YES ❑ NO 'PLATTED LOT?, '~o YES ii 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 w ww.Cityoffederalway.Com