01-103744RECEIVED
pT.oF G CONSTRUCTION PERMIT APPLICATION
APPLICATION NUMBER: �� - I d X -7 _ -O_ -�
VV iF fY �P 2 5 ?.®taiPPLICATION NUMBER: _ _ - - - - - - - - -
-
r'tY OF FEG;:R :L WAY PPLICATION NUMBER: - - - - - - - - -
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€3UILDIN DEPT. - -
**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• •
SITE ADDRESS: _ ' J -1 y t1;1 FL.' P?c,'74 -� / l) • ASSESSOR'S TAX/PARCEL #: 21f
r
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROJECT INFORMATION
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING
❑ ELECTRICAL ❑ ENGINEERIN[G VFIRE PREVENTION
PROJECT DESCRIPTION (Provide detailed description):
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
CONTACT PERSON
e
■ PEOPLE INFORMATION
NAME:
,a inG,
DAYTIME PHONE:
( 3) «/ - $03 Z.
MAILING ADDRESS (STREET ADD SS; C ,STATE, ZIP):
3� - n�� S � erg l c�x4 p
NAME:
DAYTIME PHONE:
q,96 C6150
MAILING ADDRESS (STREET ADDRESS; CITY, ATE, ZIP):
i(CL, 154A AVC Z--, A 919N
EVENING PHONE:
( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
(963)9-10:E560
CONTRACTOR'S REGISTRATION NUMBER:
EXPIRATION DATE:
NAME: � � //
DAYTIME PHONE: -
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
( )
RELATIONSHIP TO PROJECT:
❑ ARCHITECT ❑ TENANT ❑ OTHER ( DESCRIBE):
FAX NUMBER:
( ) -
:OR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT )(CONTRACTOR
E-MAIL ADDRESS:
�` DETAILED • •
EXISTING USE: 6C1.-
vC, K-yr✓1 V-1 EXISTING BUILDING ASSESSED/ APPRAISED VALUATION $ C
PROPOSED USE: tA�a�cA 14ouw- PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER
SEWER SERVICE PROVIDER:
9
K LAKEHAVEN ❑ HIGHLINE
❑ LAKEHAVEN ❑ HIGHLINE
•
❑ TACOMA ❑ PRIVATE (WELL)
❑ PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
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?
URINAL(S)
WATER HEATER(S)
DISHWASHER(S)
TOTAL:
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S)
•BLOCK
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. J
NAME/TITLE: L1 ' `i �'�� ( DATE: Cf ! `�-r� /L%l
❑ PROPERTY OWNER ❑ APPLICANT 1(CONTRACTOR
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 INSERTS)
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)
SINK(S)
WATER CLOSET(S)
MISC. ( )
INTERCEPTOR(S)
SUMP(S)
•BLOCK
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. J
NAME/TITLE: L1 ' `i �'�� ( DATE: Cf ! `�-r� /L%l
❑ PROPERTY OWNER ❑ APPLICANT 1(CONTRACTOR