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01-103896 III a _ CONS I RUCTION PERMIT APPLICATION FnF APPLICATION NUMBER: & Z_ - Z 6' 3 e9'6' L�'- /%� vv w RECEIVED - APPLICATION NUMBER: - - _ _ � 0 42001APPLICATION NUMBER: '_ - '' - - - - - - **The following is required information—Please print(in ink)or type** ;tiY OF FEDERAL Wr: Please note: Electrical, Fire Presrfip,Dguariaprits and Engineering permits may require a separate application. • a ■ PROPERTY INFORMATION SITE ADDRESS: /2�Ft�_7�9-49 /9{1,,,,c-7 / ASSESSOR'S TAX/PARCEL #: OlZ I 011- 42 / /Z" LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): . ■, PROTECT INFORMATION TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING[ FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description): t • �c--(.A � l' ©AVf - -,d& rt-Ple 7-7-P - .27 K/. PROJECT NAME: 41V1 , / / ' t / 714 "' ■ PEOPLE INFORMATION PROPERTY OWNER: NAME: DAYTIME PHONE: MAILING AD ESS(STREET ADDRESS;CITY,STATE,ZIP): CONTRACTOR: NAME: /T DAYTIME PHONE: MAILING ADDS(STRE�RESS;CITY, A ,Z / EVENING IN PHONE! - ‘/oo' /-2_7/ , c. �=49-T CAA ?&/C) A ( ) - CITY OF FEDERAL WR'(BUSINESS LICEN E BER: FAX NUMBER: f. - - ( ) - CONTRACTORS REGISTRATION NUMBER: EXPIRATION DATE: (copy of card required) z / V2pioTe . /z / 0 / / L).--00/APPLICANT: NAME: DAYTIME PHONE: MAILING / � ESS(SIRE ADDRESS, STATE,ZIP): \� 7 �� PHONE: • V _' ,'/r'' / • r ' : ? .. ;�Q�d. Ai p i'a -,11' ) ,' --' .� l RELA ONSHIP Tr •ROJ CT: FAX NUMBER: ❑ ARCHITECT [4-TENANT A OTHER(DESCRIBE): ( ) - � E-MAIL ADDRESS: CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER /: APPLICANT ❑ CONTRACTOR --II--DETAILED BUILDING INFORMATION -. EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ /., ,.-,>—‘711'..-;.,.(.2—.- SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER: ❑ LAKEHAVEN 111 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 ❑ 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 1 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 the city as a part of this application. NAME/TITLE: DATE: 7(.),--2,/ ❑ PROPERTY •WNER` P' APPLICANT ❑ CONTRACTOR FOR OFFICE USE ONLY: ❑ NEW P❑ 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