03-102074• CONSTRUcrW PERMIT APPLICATIO
CITY OF �.� RECON JED PPLICATION NUMBER: - -
Federal Way 1APPLICATION NUMBER:
MAY 2 0 2003PP�LICXHON NUMBER:
—The fojjWrlg,l�r�bNA',iQ�p Tation —` leP ase print (in ink) or type**
Please note: Electrical, Fire PrVAKMN§ rQEATand Engineering permits may require a separate application.
PROPERTY I• •
SITE ADDRESS: ASSESSOR'S TAX/ PARCEL #: Z Li / 24
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROJECT INFORMATION
TYPE OF PROJECT (This application): o BUILDING o PLUMBING o MECHANICAL o DEMOLITION
o ELECTRICAL o ENGINEERING IRE PREVENTION SYSTEM
PROJECT DESCRIPTION
Provide detailed description):
zi51.4,D/n'! Imo./�p int
PROJECT NAME:
PROPERTY OWNER: '[M:A,
AME:
_I
GyDL
CONTRACTOR: NAME:
APPLICANT:
■ PEOPLE INFORMATION
tEET ADDRESS; CITY, STA ZIP):
''iii
tEET ADDRESS; CITY, STATE. ZIP):
� �C arty �f
BUSINESS LICENSE NUMBER:
RACTOR'S REGISTRATION NUMBER:
of card required)
NAME:
u
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
tx
RELATIONSHIP TO PROJECT: '.,
❑ ARCHITECT o TENANT bOOTHE
R ( DESCRIBE):
(DAYTIME PHONE:
DAYTIME PHONE:
EVENING PHONE: I
1�
!(42-0 - Zq�
FAX NUMBER:
I EXPIRATION DATE:
i
DAYTIME PHONE:
II
i
EVENINT PHONE:
115�-
FAX NUMBER:
( A0 7z17-.z:05-2�
E-MAIL ADDRESS: I
I
CONTACT PERSON FOR THIS PROJECT: ❑PROPERTY OWNER ❑APPLICANT CONTRACTOR
D13UILDING I FORMATION
EXISTING USE:
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
EXISTING BUILDING ASSESSED/APPRAISED VALUATION ;
PROPOSED VALUATION FOR IMPROVEMENTS: $ �2� Fc
YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES o NO
❑ LAKEHAVEN ❑ HIGHLINE
❑ LAKEHAVEN o HIGHLINE
❑ TACOMA ❑ PRIVATE (WELL)
❑ PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY*
NUMBER OF BEDROOMS:
ESTIMATED SELLING PRICE:
.. ■ PROSECT FLOOR AREAS
FLOOR
EXISTING SQ. FT. -
PROPOSED SQ. FT.
TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
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) SINKS) WATER CLOSET(S) MISC. ( )
INTERCEPTORS) SUMP(S)
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:1�?d,{�rr����� C/Cly �'/�/�i� DATE:
❑ PROPERTY OWNER ❑ APPLICANT r CONTRACTOR
- FOR.OFFICE USE ONLY: ':r
CENSUS'CODE: LOT SIZ, MP 5Fv'w .is
ZONING;DESIGNATION BUILDING SHEL�.ONLY?:r a'YES ". o NO
:COMP PLANDESIGNATION
i*=, =BASIC PLAN? o YES TI NO
SECTION :TOWNSHIP RANGE - ., ^ NEW ADDRESS RE UIRED?' ❑ YES ❑ NO
PLATTED LOT?- `i' ❑ 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
www City0ffiederalway Com