01-101930 keentED
CONSTRUCTION PERMIT APPLICATION
- �� — MAY 1 5 P ' APPLICATION NUMBER: Di - ' so - _ I
CITY OF FEDERAL WAY APPLICATION NUMBER: -BUILDING DEPT. 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.
• PROPERTY INFORMATION
SITE ADDRESS: 3't Z75 32."'° IAVg- 18001 ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): LOTS 10 E ON r uE
" Tj}6T l')9rvriJk.(5 Coi41°oiv) riz. y v3 Jc y9t)K ai. I 'WLwidtrt)c; rK YJo/N.J OS iRIaL))/WiZ✓J t1Y (i(
k\Mt ri echiw I►u(r }1)O, [c Gt oc1 I h ou 131 7
• PROJECT INFORMATION
TYPE OF PROJECT(This application): o BUILDING C PLUMBING o MECHANICAL C DEMOLITION
o ELECTRICAL o ENGINEERING 3 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): C L '?3 h) Y 1£pJ T i AL 3TA i'OP0 5 y S�JI:r"i
Fox Co )11 vv ‘ y m I 3 g'm ert(i tz rJ /10014-.)7' 9 5 I,(sx n,
PROJECT NAME: l;v91d IT V L or CY)LC C)z-N J K✓Z
• PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
C►MT L oNif. (253 ) 635 - 5q8 )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
322.75 3Z ' ivf 5 • I Fri),;,OIL �v✓Iy w4' I e001
CONTRACTOR: NAME: DAYTIME PHONE:
( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
CITY OF FEDERAL WAY$USINE55 LICENSE NUMBER: ... - _ _ — FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
/
APPLICANT: (ryil -!` � DAYTIME PHONE:
r) ,��► I�1 s ►2 -{�{'Iik� � 4 ( 153)36 3 -3 oO
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): ) EVENING PHONE:
PO TO `/`/5$O Lkze-a96 wet 98'/99-os8U (2s3 )3f33 -3SoL1
RELATIONSHIP PROJECT: 1; ul ern RAI J 04,09 FAX NUMBER:
0 ARCHITECT C TENANT fr OTHER(DESCRIBE): ,) 3 i H ry ( Z y'3) 3 63 -j?0 7
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: C PROPERTY OWNER ifl APPLICANT C CONTRACTOR
• DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $qq A
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ ,7
SPRINKLERED BUILDING? o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:o YES ❑ NO
I • •
WATER SERVICE PROVIDER: o LAKEHAVEN ❑ HIGHLINE [ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
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:
• 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 o GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) o 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 supplied to t ci as "part of this a cation. /
NAME/TITLE:i�L�iY�C / ole/ Sil F�j'r/i''U�< DATE: —1 — 1
o PROPERTY OWNER ❑APPLICAN [CONTRACTOR