02-100094 • •
OF c 0 :ofe0 CONSTRUCTION PERMIT APPLIC TION
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(x,11.6t�pQq ng is required information-Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
• PROPERTY INFORMATION
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SITE ADDRESS: -- 4P At
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LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACHEPA TE DESCRIPTION IF LENGTHY):
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• PROJECT INFORMATION
TYPE OF PROJECT(This application): BUILDING PLUMBIN MECHANICAL DEMOLITION
ELECTRICAL ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description):
PROJECT NAME: ,i" N , `r L -J- /"7/
• PEOPLE INFORMATION
PROPERTY OWNER: NAME: } ((�� DAYTIME PHONE:
NAME: t-e�_e,--1. ,,,LQ V`.' G�;," G' : - fVI ( )MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZI
CONTRACTOR: NAME: DAYTIME PHONE:
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MAILING ADDRESS(STREET ADDRESS;CITY STATE,ZIP): EVENING PHONE:
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CITY OF FEDERAL BUSINESS LICENSE NUMBER: FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER: •n ,4 m 6E
�,y c O 6 '3 L S EXPIRATION/ATE: /ZOO
(copy of card required) 1/� C,1/ e
APPLICANT: NAME: 1 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
• DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
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: $
■ PROJECT FLOOR AREAS
11
FLOOR EXISTING S..FT. PROPOSED S•.FT. ' tt AL
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) , I
DUCT(S) V GAS PIPE OUTLET(S)f'O HEAT SOURCE: ELECTRIC GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) I 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.( J4ZW`eir)
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 informationnsupplied to the city as a part
part of this application. /
NAME/TITLE: V CIA l 6 Te r+5 DATE: 7- C 7"'
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
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
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