01-101955y �,o. • CONSTRUCCN PERMIT APPLICATION
Ems - ILEI=--r--I ED APPLICATION NUMBER:
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PPLICATION NUMBER:
MAY 167001 APPLICATIONNUMBER:
**The following is requiredopformation - Please print (in ink) or type**
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Please note: Electrical, Fire PrWntion Systems and Engineering permits may require a separate application.
PROPERTY INFORMATION
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SITE ADDRESS: 3 b cwcf���yTC� ASSESSOR'S TAX/PARCEL #: Z a �% (6
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
r; . ■ PROJECT INFORMATION
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERINGWR--rIRE PREVENTION SYSTE
PROJECT DESCRIPTION (Provide detailed description): V P - GKAY) (✓ %a tJ L- 0 w��- Ch 0'�� Q L
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PROJECT NAME: �l2 h viii cl .S C��1 G .dN��� !/�2 L /i Gc' %�� yV� Z Z* //&n
PEOPLE INFORMATION
PROPERTY OWNER: I NAME: /
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
CONTRACTOR:
DAYTIME PF
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NAME:
-/��``/PSn,y'S ,ter k c c u l�Mc1 7-
DAYTIME PHONE:
-MAILING
MAILING �ADDRESS((SSTRE�ET ADDRESS, �✓CITY, STATE1,� %-IP-):
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EVENING PHONE:
(;'<JI)6S-3
—�7 1
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER: �J /� r�
V / 6 0
EXPIRATION DATE:
(copy of card required) /V t�
APPLICANT: NAME:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
d2 0 , 6 q(>( 3 --b �t�Z 6C
RELATIONSHIP TO PROJECT: �,�
El ARCHITECT El TENANT l- OTHER ( DESCRIBE)
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT
EXISTING USE:
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
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we ,c.
L7 CONTRACTOR
■ DETAILED BUILDING INFORMATION
EXISTING BUILDING ASSESSED/ APPRAISED VALUATION
❑ YES ❑ NO
DAYTIME PHONE:
(ado ) 4 '�-b G &'�i
EVENING PHONE:
(;6 � )U rd
FAX NUMBER:
( )
E-MAIL ADDRESS: -
PROPOSED VALUATION FOR IMPROVEMENTS: $
FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: YES ❑ NO
❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
•
"NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS:
•
ESTIMATED SELLING PRICE:
■ PROJIECT 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)
BOILERS)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHER(S)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTOR(S)
■ -' mulkES
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEMS)
FAN(S) HOOD(S) WOODSTOVE(S)
FIREPLACE INSERTS) 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
SINK(S) WATER CLOSET(S) MISC. ( )
SUMP(S)
%TCCtATMER/STGNATURE RLC
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 -b yr I , l ds -IP -50 q DATE: I� 6��%� A -'aoC'
❑ PROPERTY OWNER ❑ APPLICANT [9 -CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION
❑ REPAIR ❑ TENANTIMPROVEMENT
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 • 2S3-661-4000 - FAX: 2S3 661-4129