01-101958.ft.
REVIVED
�.o. CONSTRUC01 N PERMIT APPLICATION
41: R
E - MAY 16 2001 APPLICATION NUMBER: �
CITY OF FEDERAL WAY PPLICATION NUMBER:
BUILDING DEPT. PPLICATION NUMBER: - -
**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.
PROPERTY
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SITE ADDRESS: 3 (. .2 0 ASSESSOR'S TAX/PARCEL #: 2 O (i f!Q - 9� T— —
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROJECT INFORMATION
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING WrIRE PREVENTION SYSTE
PROJECT DESCRIPTION (Provide detailed description): (JP - j, -r-40 L Tb L)4-- 3 6 y
PROJECT NAME: wl2 l� G�/iA (/6' .S C%�1 G %► .�Ml�v l��Z L j� GC %��" �SS/�L lS-
PEOPLE• •
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
CONTACT PERSON
EXISTING USE:
NAME: /ol�I�i�� DAYTIME PHONE: _
MAILING ADDRESS (STREET ADDRESS; CITY, STAY_ZIP):
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NAME:
'r116 " 456. is
DAYTIME PHONE:
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MAILING ADDRESS (STREET ADDRESS; CITY, STATE, IP):
EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
_ _ — _ _ _ _ —
FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER:
*7/°�/6 �Q7_
EXPIRATION DATE:
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(copy of card required)
NAME:
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DAYTIME PHONE:
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MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
RELATIONSHIP TO PROJECT: LL
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El ARCHITECT ❑ TENANT P OTHER ( DESCRIBE):
FAX NUMBER:
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E-MAIL ADDRESS:
FOR THIS PROJECT: El PROPERTY OWNER El APPLICANT L7 CONTRACTOR
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
■ DETAILED BUILDING INFORMATION
EXISTING BUILDING ASSESSED/ APPRAISED VALUATION
❑ YES ❑ NO
PROPOSED VALUATION FOR IMPROVEMENTS: $
FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: PrYES ❑ NO
❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
• • AN
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**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
AIR HANDLING UNIT(S)
FIRST
GAS LOG(S)
REFRIG. SYSTEM(S)
BBQ(S)
SECOND
HOOD(S)
WOODSTOVE(S)
BOILERS)
THIRD
RANGE(S)
MISC.( )
COMPRESSOR(S)
FOURTH
DUCT(S)
OTHER FLOORS (DESCRIBE)
HEAT SOURCE:
El ELECTRIC ❑GAS
DECK
BATHTUB(S)
GARAGE
HOW MANY FLOORS?
URINAL(S)
WATER HEATER(S)
DISHWASHERS)
TOTAL:
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S)
'%TCC1LOTMER/SIGNATURE BLC
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: (r-fW "-'fI,
❑ PROPERTY OWNER ❑ APPLICANT/ONTRACTOR
r-nD nF:rTrr I ICF nN1 y
DATE: /I 42Y - A - 'ao 0 /
El NEW V` vv❑ ADDITION ❑ ALTERATION
Indicate number of each type of fixture
CENSUS CODE:
LOT SIZE:
MECHANICAL
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
AIR HANDLING UNIT(S)
EVAPORATIVE COOLER(S)
GAS LOG(S)
REFRIG. SYSTEM(S)
BBQ(S)
FAN(S)
HOOD(S)
WOODSTOVE(S)
BOILERS)
FIREPLACEINSERT(S)
RANGE(S)
MISC.( )
COMPRESSOR(S)
FURNACE(S)
DUCT(S)
GAS PIPE OUTLET(S)
HEAT SOURCE:
El ELECTRIC ❑GAS
PLUMBING
BATHTUB(S)
LAVATORY(S)
URINAL(S)
WATER HEATER(S)
DISHWASHERS)
RAIN WATER SYS.
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S)
SHOWER(S)
WASH MACHINE OUTLET
GAS PIPE OUTLET(S)
SINK(S)
WATER CLOSET(S)
MISC. ( )
INTERCEPTORS)
SUMP(S)
'%TCC1LOTMER/SIGNATURE BLC
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: (r-fW "-'fI,
❑ PROPERTY OWNER ❑ APPLICANT/ONTRACTOR
r-nD nF:rTrr I ICF nN1 y
DATE: /I 42Y - A - 'ao 0 /
El NEW V` vv❑ 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 • 253-661-4000 • FAX: 253-661-4129