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01-104272 CONSTRUC)N PERMIT APPLICATION R,FIvEr) �� FryEID ,?�ejl ; L APPLICATION NUMBER: O -/ 4 Y121121- C f� ms-of NUMBER: - - Lai r Ur- i ,_,.....a-WAY APPLICATION NUMBER: -- - - BUILD:e C DEPT. L?, Q�� **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. I ■ PROPERTY INFORMATION SITE ADDRESS: 3)7. 1 , C f I ,0 . ' SSOR'S TAX/PARCEL#: - LEGAL DESCRIPTION OF SUBJECT PROPERTY ATTACH SEPARATE DESCRIPTION IF LENGTHY): - ' _. • PRO]ECT INFORMATION • TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL 0 ENGINEERIN9FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description): 1 K4r-ki 1 ' vNeA.N....,, . .-.) x-e__..- not r------ 5j51"e•toN....•-• PROJECT NAME: . l I1 - ■ PEOPLE INFORMATION PROPERTY OWNER: NAME: Lti.I( 0ItsDAYTIME PHONE: - MAILING AD S(STREET ADDRESS;CITY,STATE ): CONTRACTOR: NAME: A / % H t/ a;(SIREET App2ES� ATE ZIP):.44,! < EVENING PHONE: - (9 Ill CITY OF FE''n AY BU ti LICENSE NU.MBEIg���(�^/ s� NUMBER: IIl CONTRACTOR'S REGISTRATION NUMBER: F TDA2l g(copy of card required) / i5)Q34Q3 0�/ APPLICANT: Eo _7;6185 � 85 ali...„3'w - ux, EMAILING (STREET TATE,ZIP): (EVENING PHONE: RELATIO SHIP T PROD - FAX NUMBER: ❑ ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): ( ) - E-MAIL ADDRESS: CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ' . •PLICANT = 0' •'i• • - ■ DETAILED BUILDING INFORMATION EXISTING USE: V 1 `"\.EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ &Du0- d) SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ Yr- 0 NO WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑TACOMA ❑ PRIVATE( - SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) JQi�e s 1 . . Co7 4 �. **NEW RESIDENTIAL CONSTRUCTION ** • NUMBER OF BEDROOMS: ESTIMATED SEALING PRICE: $ 1 ■ 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 D GAS PLUMBING BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S) 1 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 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 d ' arises out of the reliance of the dty,induding its officers and employees,upon the accuracy of the information supplied to th as a part of this application. r L NAME/TITLE: DATE: 1 1 .-(7(0/ ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR FOR OFFICE USE ONLY: _❑ NEW=' ,__- 0 ADDITION -❑ ALTERATION -❑;REPAIR - - ❑ TENANT IMPROVEMENT CENSUS_CODE: - - -LOTSIZE: . - ZONING) ESIGNATION: BUILDING SHELL ONLY? .❑ YES .❑ NO :COMP,PL`AN`DESIGNATION BASIC PLAN?'-'- ❑ YES` 0 NO SECTION;i`::`_ -TOWNSHIP RANGE NEW ADDRESS REQUIRED? 0 YES 0 N PLATTED LOT? . 0 YES 0 NO CHANGE OF USE? ❑YES 0 NO COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129