01-103607_ • CONSTRUCTION PERMIT APPLICATION
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APPLICATION NUMBER:
20 APPLICATION NUMBER:
APPLICATION NUMBER: - -
,)�*t,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.
SITE ADDRESS: 36a 0 I G®VC�6�JE),(/� ASSESSOR'S TAX/PARCEL
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPT' Provide detailed description): Zjy $ 441- 4 11/eO . 1-,„j J✓J
PROJECT NAME:
PROPERTY OWNER: I NAME:
CONTRACTOR:
APPLICANT:
MAILING ADDRESS (STREET ADDRESS; CITY,
2 -('-) a i .Faun,
DAYTIME PHONE:
NAM
DAYTIME PHONE:
u ? j rewy
05--3 ) A s - A-'eos
MAfLING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
/
EVENING PHONE:
CITY F FEDERAL WAY BUSINESS LICENSENR:
FAX NUMBER:
—
—
_
CONTRACTOR'S REGISTRATION NUMBER:
EXPIRATION DATE:
(copy of card required)
NAME: DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): /EVENING PHONE:
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER ( DESCRIBE): ( -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
EXISTING USE:
PROPOSED USE:
EXISTING BUILDING
RAISED VALUATION $
ED VALUATION FOR IMPROVEMENTS:
SPRINKLERED BUILDING? OYES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN 0 HIGHLINE ❑ PRIVATE (SEPTIC)
NO
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS:
ESTIMATED SELLING PRICE:
■ PROJECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
BUILDING SHELL ONLY? ❑ 'YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
FIRST
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
AIR HANDLING UNIT(S)
BBQ(S)
BOILER(S)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHER(S)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTOR(S)
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
FAN(S) HOOD(S) WOODSTOVE(S)
FIREPLACE INSERT(S) RANGE(S) MISC. ( )
FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
LAVATORY(S) URINAL(S) WATER HEATER(S)
RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
SHOWER(S) WASH MACHINE OUTLET
SINKS) WATER CLOSET(S) MISC. ( )
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 ses out of the reliance of the city, including its officers and employees, upon the accuracy
of the information supplied to the city?pgyt of this application.
NAME/TITLE: /" DATE: �� 7 " �✓
❑ PROPERTY OWNER ❑ APPLICANT 64'CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ 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 - 253-661000 • FAX: 253-661-4129