01-103106 Ar Q% 7_ CONSTRU•ON PERMIT APPLICATION
F—D — APPLICATION NUMBER: 0/- 40.3/416 -
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%\' gt3\�-O�� APPLICATION NUMBER: - -
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.
'Z... - - - - -, - - - ' - ■ PROPERTY INFORMATION - - • ..
SITE ADDRESS: ,k42.5.- 5, U' ' 35g S+ ASSESSOR'S TAX/PARCEL #:C,�gi 03 - 'Dll
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
r'. " • - - ■ PROJECT INFORMATION
TYPE OF PROJECT(This application): �❑ BBUILDING CI PLUMBING ❑ CHANICAL ❑ DEMOLITION
• - l�'ELECTRICAL ❑ ENGINEERING VFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): (JJSTAu4ctOt.( 01R /J EW L�LA3
00(-TA-C-1 p i 2 ,4-( W? __5‘(sre7v1 , e, _c , A-D D t r1tt6 n-(
II C • Ina,/ b IU C ! l �I 41.1i ' . cS5%V.4e-
PROJECT NAME: {l C1L t4 C L('u I-OK
■ PEOPLE INFORMATION . -
PROPERTY OWNER: N DAYTIME PHONE:
' ecifH k 1A/ . CLe V N ( ) -
MAILING ADDRESS(STREET ADDRESS,CITY,STATE,.NO:):
2A-25- c
5 .°, 3� S
6 '" '+
CONTRACTOR: NAME: DAYTIME PHONE:
1—�r—ce Co trotot_ 5((.57-&-714..0 (Z53 ) 83Fr - 4cer0
MAILING ADDR SS(STREET ADDRESS,CITY,STATE,ZIP): EVENING PHONE:
/e0 .- 3o1( 50 f1eicieei, c,WWA q�O3 (z53 )s-3 - - if4cry
CITY OF FEDERAL WAY BUSINESS LICENSE NUMB FAX NUMBER:
- - ( ) -
CONTRACTOR'S REGISTRATION NUMBER: / y� EXPIRATION DATE: ,, 7
�
(copy of card required) --EW 7 b IC C S I C( L• /( / 05- v/ZO
APPLICANT: NAME: DAYTIME PHONE:
-1-AirF Coli CDA/1714R S YS r 4s (253 ) Z531- -qc(d-O
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
"0... 30 /u 4pC( c/4 uA QBoS 8 ( ) Fs3 - - 4 LOrtrj
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT CITENANT IFIL<HER(DESCRIBE):,/ TX4CT61--- ( ) -
E-MAIL ADDRESS: •
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
-- - •■ DETAILED BUILDING INFORMATION -
EXISTING USE: COPLatataCei EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
C
PROPOSED USE: C'. PROPOSED VALUATION FOR IMPROVEMENTS: $ e/ S-7"0
SPRINKLERED BUILDING? YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES kle4
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 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
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: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ 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,including its officers and employees,upon the accuracy
of the information s -l:,0-• W a as a part of this application.
NAME/TITL ./ /_— je5I�.S"ta i-V DATE: -6"'I
❑ PROPERTY OWNER i7 •PPLICANT U-C,NTRACTOR
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? 0 YES ❑ NO CHANGE OF USE? ❑ YES ❑ NO