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1ECEIVED CONSTRUCTION PERMIT APPLICATION
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APR 1 2 2091 APPLICATION NUMBER: - -
t!� APPLICATION NUMBER: - -
OF FEDERAL WAY
**i nee 1owStNjt3Tired information—Please print(in ink)or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
- - [ 111 PROPERTY INFORMATION - -
SITE AD+DKES✓ W WS K 0/rLi T • St* ASSESSOR'S TAX/PARCEL #: Z/_ ----'21d 3 - e1-2
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROJECT INFORMATION ..
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL EMOLITION
ELECTRICAL LI ENGINEERINGEl FIRE PREVENTION STEM
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PROJECT DESCRIPTION (Provide detailed description): AJ '' it /` -- -
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PROJECT NAME:
■ PEOPLE IN IRMAT1 N
PROPERTY OWNER: NAME: DAYTIME PHONE:
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RESS(STREET ADDRESS;C ,S7A �•' -�`
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CONTRACTOR: NAME ;s: DAYTIME PHONE:
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MAADDRESS(STREET ADDRES ,STATE,ZIP): EVENING PHONE:
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are OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
_ _ _ _ _ _ - _ (2Gy C ) 76 7 -3 3S-
CONTRACTOR'S REGISTRATION NUMBER: / r EXPIRATION DATE:?
(copy of required) •
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APPLICANT: NAME: DAYTIME PHONE:
64.7.5r -. =_ 11� , ,qz S'_ ( ) -
MAILING ADDRESS(STREET ADDRE ,STAT,ZIP): ,, EVENING PHONE:
1 RELATIONSHIP TO PROJECT: AK FAX NUMBER:
CI ARCHITECT El TENA d OTHER( DESCRIBE): �2i' ` fI r L.1., ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: LIPROPERTY OWNER CIAPPLICANT Q CONTRACTOR
■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO
! WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN 111 HIGHLINE ❑ PRIVATE(SEPTIC)
1
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ. FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
■='FIXTURES .;
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 INSERT(S) RANGES) MISC.( )
COMPRESSOR(S) F •CE(S)
DUCT(S) GAS PIP TLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLU•.'• G
ALS WATER HEATER(S)
BATHTUB(S) LAVATORY(S)--� AL(S)
DISHWASHER(S) RAIN WAT€R SYS. VACUUM BREAKER(S) CIELECTRIC CIGAS
DRINKING FOUNTAIN(S) SHONE//R(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) frPNK(S) WATER CLOSET(S) MISC. ( )
INTERCEPTOR(S) SUMP(S)
■ DISCLAIMER/SIGNATURE 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.
NAME/TITLE: 6, V UG' /I`‘e-S • DATE: 17//i 1
❑ PROPERTY OWNER ❑ APPLICANT C LCONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION El REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION : BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION BASIC PLAN? El 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