Loading...
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