01-104111 « RECEIVED CONSTRUCT ION PERMIT APPLICATION
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APPLICATION NUMBER: C1 1 - L O t L L L -Q _
FEB 2 12002 APPLICATION NUMBER: -
(APPLICATION NUMBER: - -
CITY OF FE
**Thfl�n gd(/la18 information—Please print(in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
• //�•/� / • ■ PROPERTY INFORMATION 2 C r 9 /
SITE ADDRESS: 0 leO3 1 2141 Ale. S ASSESSOR'S TAX/PARCEL #: 3 a / 'T - / 60
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
•
. - . . ... . - • PROSECT INFORMATION - . - -
TYPE OF PROJECT(This application): Cl BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
ELECTRICAL ❑ ENGINEERING❑ FIRE�►PREVENTION SYSTEM .
•
PROJECT DESCRIPTION(Provide detailed description): LO VD TIC/ rYtoS&fLaero/
PROJECT NAME: i 1'Q
. ■ PEOPLE INFORMATION ..
PROPERTY OWNER: NAME: DAYTIME PHONE:
CcU- De [-co (Z53)( 70 -I Zi"o
MAILING PoADDRESS
q.II.x 3�T Ri 3CITY,STATE fIP):
e aJ I4/aj L4J1 f PO(()3
CONTRACTOR: NAM DAYTIME PHONE:
In dwr Car)f r-r S js/ei i -�-nc . (Z53)s3c3 -/L/
MAILING ADDRESS(STREET ADDRESS;CITY,STATE, EVENING PHONE:
jig vi -ole-i- Mead t vv St S ( 5 )S3g - P-0.41
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: . FAX NUMBER:
I - C( 1402785 -CO-8- (23)S3 , -lc'13
CONTRACTORS REGISTRATION NUMBER: EXPI TION DATE:
IN 00 0 C, 'S 005 o8 ` / .,2v 1. 00.
APPLICANT: NAME:
DAYTIME PHONE
( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT El TENANT ❑ OTHER( DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER El 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: El LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
•
••NEW RESIDENTIAL CONSTRUCTION ONLY** I
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT FLOOR AREAS •
FLOOR EXISTING SQ.FT. PROPOSED SQ. FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
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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)
N 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 supplied to the city as a part of this application.
NAME/TITLE: ' DATE:
❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY: I
NEW , - ;0 ADDITION 0 ALTERATION REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: = LOT SIZE:
ZONING DESIGNATION : BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION - _ IBASIC PLAN? .❑ YES `'❑ NO :=
SECTION . TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO.
PLATTED LOT? 0 YES ❑ NO CHANGE OF USE? " ❑ YES ❑ NO
COMMUNITY DEVELOPMENT SERVICFS•33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
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