01-101883effeelvet5
cffyof/,.—=— 0 CONSTRUOON PERMIT APPLICATION
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MAY 14 79,jAPPLICATION NUMBER: p
CITY OF FEDERAL WAy PPLICATION NUMBER: -
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.
//�� PROPERTY O.
MATION
SITE ADDRESS:/ yV - ,�� oZ%�n��S ASSESSOR'S TAX/PARCEL #: S Q - Q 0- S j
LEGAL DICRIPTION OFSUyCT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY): A �C i A)G
■ PR03ECT INFORMATION
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERIN59 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): S J ('4, to 1 4--,4e �-Pf :L
PROJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
■ PEOPLE INFORMATION
NAME:
DAYTIME PHONE:
(2o �Z/9 - S10�{
MAILING ADDRESS (STREET ADDRESS;CITY, STA ,ZIP):
9&4 Z
NAME:
DAYTIME PHONE:
MAILING ADD (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER:
EXPIRATION DATE:
(copy of card require
NAME:` DAYTIME )
^ G
MAILINGADDRESS {STRE ADDRESS; CITY, STATE, ZIP): PHONE:
3 2 ! - . S a 009, (Z' 3) 9,25'- /Sly
RELATIONSHIP TO PROJECT. FAX NUMBER:
❑ ARCHITECT TENANT ❑ OTHER( DESCRIBE): ( )
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: y PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR I I
EXISTING USE: �� �%, 2 -es 'A EXISTING BUILDING ASSESSED/APPRAISED VALUATION 3 �5-Qi 60f)
PROPOSED USE: �I? S cue . PROPOSED VALUATION FOR IMPROVEMENTS: % S-0 Q, UO - 0 D
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED-YES ❑ NO
WATER SERVICE PROVIDER: XLAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: ? LAKEHAVEN 11 HIGHLINE 11 PRIVATE (SEPTIC)
..NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS:
ESTIMATED SELLING PRICE:
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
FIRST
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
AIR HANDLING UNIT(S)
BBQ(S)
BOILERS)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHERS)
DRINKING FOUNTAINS)
GAS PIPE OUTLET(S)
INTERCEPTORS)
It
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
FAN(S) HOOD(S) WOODSTOVE(S)
FIREPLACE INSERTS) RANGE(S) MISC. ( )
FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
LAVATORY(S)
RAIN WATER SYS.
SHOWER(S)
SINKS)
SUMP(S)
URINALS)
VACUUM BREAKER(S)
WASH MACHINE OUTLET
WATER CLOSET(S)
1TScLATMER/SIGNATURE BLC
WATER HEATER(S)
❑ ELECTRIC ❑ GAS
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 supplie- to the city as a art of this application.
NAME/TITLE: ! ' I DATE: /
IL -
I& PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
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❑ •NEW sy` vJ❑ ADDITION ❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION:
BUILDING SHELL ONLY? ❑ 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 • P.O. BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129