00-105860 at"(
CONDUCTION PERMIT APPLICATIC
�� �y E - � APPLICATION NUMBER: (20._ - 1.0_s J�Q U -Ep
APPLICATION NUMBER: _ _ . _ _
DEC 012
APPLICATION NUMBER: _ _ -._ _ _ _ _ _ - _
**TheIoll tir ig ekdAtYformation—Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
- ;, ■ PROPERTY INFORMATION •
SITE ADDRESS: /r( '' :>/� 0 ( Fc)c2 4? IC) ASSESSOR'S TAX/PARCEL#:
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
U r ti r „!., -_:■ PROJECT INFORMATION • - .
TYPE OF PROJECT(This application): 0 BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
• ❑ ELECTRICAL ❑ ENGINEERINGJq FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): /4/S179/-,/ 77 Ur/ g :TY(AA. ,0/11
PROJECT NAME: 1.7 ho
c-cl,-) 1jt 0A4, '5 lqaA, .
PEOPLE INFORMATION - - -
DAYTIME PHONE:
PROPERTY OWNER: NAME:
— P/1 43/4CAS t,4/-"r/V�J-iwE5r ,e&-s-,-;44p..(4-,17— ( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
`-. :V 3/)-ril !-9Gi, I� ✓e- A-4. Gtm-y
DAYTIME PHONE:
_ CONTRACTOR: NAME: ( ) _
3 Cvwu. a (-' p(A:at/►1t
MAILING ADDRESS(STREET ADDRESS;CITY,STA P): EVENING PHONE:
( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
( )
CONTRACTORS REGISTRATION NUMBER EXPIRATION DATE:
Il
DAYTIME PHONE:
APPLICANT: NAME:
S Bell /e/7-9/ �ys%h--ni5 �_A/C° (:l j ) i'./r -fZt
MAILING ADDRESS(STREET ADDRESS;CITE',STATE,ZIP EVENING PHONE:
/ Q s7- sE- /dLy,44X.u� L 4 >f:,'7 ( ) -
�/ �'1 ��.�f � �
RELATIONSHIP TO PROJECT: FAX NUMBER:
CIARCHITECT ❑ TENANT CIOTHER(DESCRIBE): ( ) _
E-MAIL ADDRESS:
II CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER [ APPLICANT 0 CONTRACTOR
■ DETAILED BUILDING INFORMATION . • •
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ G
PROPOSED USE: r
PROPOSED VALUATION FOR IMPROVEMENTS: $ �` k 5 - C'
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES Cl
WATER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOM. ESTIMATED SELLISRICE: $
• ■ 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:
it c, r• _ +.. ..:-.
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 a GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC U 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 arty daim(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 daim 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.6/.4i
NAME/TITLE: 7.....--:13-712 -72/7 t DATE: //(2) /.- 'l
a PROPERTY OWNER ('APPLICANT a CONTRACTOR
OROFFICE USE,ONLY:- I
iVEW r T_ .ADOI7ION ALTERATION R V M '
. '��REP„AiR��.. �ENANT�MPROVEMENT ,_�=
ONING_pESIGNATIONi` -- - UILOINGSHELLONLY1k l WES 15143INO -
�oA Pl TAN DESIGNATION �`
_:...... _:. M �� � _�BASZcLi►N� fl YEs��X104 �.�— � �:
SECTIONS __-.: TOWNSHIP RANGE .t VEV IDORESS REQUIRED? �. (ESS 'VOA,
LATTED tOT2a 'YES NO }#
_ �,�- �- ;(�iANGE�DF�lSE7� ......:3���'�(ES,
ODMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•P.O.BOK 9718•FEDERAL WAY,WA 98063.9718.253-661-4000•FAX:253-661-4129