Loading...
01-101667Cff•Off TCONSTR N PERMIT APPLICATIONLICATION NUMBER: - t2 72001/�vNQa-� LICATION NUMBER: _ ©o- 103*&Z —DI PPLICATION NUMBER: CITyQut OFED F PE j Ay **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. rPROPERTY INFORMATION SITE ADDRESS: S ao td ASSESSOR'S TAX/PARCEL #: _ _ _ _ _ _ - LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY): PR03ECT INFORMATION TYPE OF PROJECT (This application): lb BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM DESCRIPTION (Provide detailed description): r Pe. PROJECT NAME: PEOPLE• • PROPERTY OWNER: NAME: DAYTIME PHONE: , MAILING ADDRESS (STREET ADDRES , CITY, STATE, ZIP): 0 c -)6 3S '4 . ,40-e S, ID -e5 ftjAr5 .-i _n -- CONTRACTOR: NAM _10C, < < I 6s (C 2 i) 5'6-7 - g / e ry :;e e vi C d S 4 A61LING AD SS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE: (eP , 'i�o X 13 6 75s4 Lrz k W A 2-- ( ) .Sew- e CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER. FAX NUMBER: _ _ — _ _ _ _ _ _ — CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE: (copy of card required) APPLICANT: NAME: DAYTIME PHONE: MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE: ) RELATIONSHIP TO PROJECT: FAX NUMBER: ❑ ARCHITECT []TENANT ❑ OTHER( DESCRIBE): E-MAIL ADDRESS: - CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR - - a po EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ /goo / 0 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: $ ■ PROTECT FLOOR AREAS 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) BOILER(S) COMPRESSOR(S) DUCT(S) BATHTUB(S) DISHWASHERS) DRINKING FOUNTAIN(S) GAS PIPE OUTLET(S) INTERCEPTOR(S) Indicate number of each type of fixture MECHANICAL EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEMS) FAN(S) HOOD(S) WOODSTOVE(S) FIREPLACE INSERT(S) RANGE(S) MISC. ( ) FURNACE(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS PLUMBING LAVATORY(S) URINALS) WATER HEATER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS SHOWER(S) WASH MACHINE OUTLET SINK(S) WATER CLOSET(S) MISC. ( ) SUMP(S) 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.41ises out of the reliance of the city, including its officers and employees, upon the accuracy of the informatio suppli d e city a part of this application. 4,.e�. s 5 Co NAME/TITLE: S�� "� . DATE: � � D ❑ PROPERTY OWNER ❑ APPLICANT %CONTRACTOR FOR OFFICE USE ONLY' ❑ NEW ❑ 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 COMMI LAITY DFVFI OPMENT SERVICES • 33530 FIRST WAY SOUTH • P.O. BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129