01-101954• CONSTRUCON PERMIT APPLICATION
VV FAY 3-�� PPLICATION NUMBER:
PPLICATION NUMBER: - -
- - - - - - - - - MAY 16 ?99'1 APPLICATION NUMBER:
"The foltQwitV;isirequikvditifatination — Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
nnPROPERTYINFORMATION
SITE ADDRESS: 3 4 2 01' 6WC- o6 :(TfV ASSESSOR'S TAX/PARCEL #: 9a
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
Y`:. :.: ■ PROJECT INFORMATION
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING®�RE PREVENTION SYSTE
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PROJECT DESCRIPTION (Provide detailed description): oe - GKAh C `TO
PROJECT NAME: wl2-h Gy,A (, J CQ &-c'
PEOPLE• •
PROPERTY OWNER: I NAME:
CONTRACTOR:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE,
DAYTIME PHONE:
NAME:
DAYTIME PHONE:
/
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, 1P):
EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER:
L N P C CO
EXPIRATION DATE:
v
(copy of card required) -7—
APPLICANT: NAME:
C c'j k Gc (5-- )'I-JaP7.0ru
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
d2
RELATIONSHIP TO PROJECT: �,�
El ARCHITECT El TENANT 1�rOTHER ( DESCRIBE)
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT
EXISTING USE:
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
�s�tT�Ac,fZ �
L7 CONTRACTOR
■ DETAILED BUILDING INFORMATION -
DAYTIME PHONE:
EVENING PHONE:
(ay 6 )U 6J
FAX NUMBER:
)
E-MAIL ADDRESS:
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
D1G
PROPOSED VALUATION FOR IMPROVEMENTS: $ er "
❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: f$,l€S ❑ NO
❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
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**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
LOT SIZE:
ZONING DESIGNATION:
AIR HANDLING UNIT(S)
FIRST
GAS LOG(S)
REFRIG. SYSTEM(S)
BBQ(S)
SECOND
HOOD(S)
WOODSTOVE(S)
BOILER(S)
THIRD
RANGE(S)
MISC. ( )
COMPRESSOR(S)
FOURTH
DUCT(S)
OTHER FLOORS (DESCRIBE)
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
DECK
BATHTUB(S)
GARAGE
HOW MANY FLOORS?
URINALS)
WATER HEATER(S)
DISHWASHER(S)
TOTAL:
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
DRINKING FOUNTAINS)
•rFIXTURES
•
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: GC�� J 11 -s -1P-50 N DATE: /I d y- A- a00 /
❑ PROPERTY OWNER ❑ APPLICANT /ONTRACTOR
FOR OFFICE USE ONLY:
Indicate number of each type of fixture
❑ NEW ❑ ADDITION ❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
MECHANICAL
LOT SIZE:
ZONING DESIGNATION:
AIR HANDLING UNIT(S)
EVAPORATIVE COOLER(S)
GAS LOG(S)
REFRIG. SYSTEM(S)
BBQ(S)
FAN(S)
HOOD(S)
WOODSTOVE(S)
BOILER(S)
FIREPLACE INSERTS)
RANGE(S)
MISC. ( )
COMPRESSOR(S)
FURNACE(S)
DUCT(S)
GAS PIPE OUTLET(S)
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S)
LAVATORY(S)
URINALS)
WATER HEATER(S)
DISHWASHER(S)
RAIN WATER SYS.
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
DRINKING FOUNTAINS)
SHOWER(S)
WASH MACHINE OUTLET
GAS PIPE OUTLET(S)
SINK(S)
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: GC�� J 11 -s -1P-50 N DATE: /I d y- A- a00 /
❑ PROPERTY OWNER ❑ APPLICANT /ONTRACTOR
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 • P.O. BOX 9718 • FEDERAL WAY, WA 98063-9718 • 2S3-66111000 • FAX: 253-661-4129