01-101505-0� CONSTRUCTION PERMIT APPLICATION
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�� F= E�=L PPLICATION NUMBER:-
PPLICATION NUMBER: - -
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 INFORMATION
SITE ADDRESS: 17�' o ` � - ASSESSOR'S TAX/PARCEL
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
y ■ PROJECT INFORMATION
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
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PROPERTY OWNE
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CONTRACTOR:
APPLICA
1 PEOPLE INFORM NTION
NAME: DA E PHONE:
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MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
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DAYTIM PHONE:
A RES E AD/LESS, ST�A7TEjZ�):
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EVENING PHONE:
ITY O ERAL WAY BUSINESS LICENSE NUMBER: —
FNUMBER'
CONTRACTOR'S EGISTRATION NUMBER:
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EXPI#ION DATE:�
NAME: _ `r
DAYTIME PHONE:
MAILINDR�S ( REET� ESS; CITY, STATE,
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Q8166
EVENING PHONE:
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RELATIONSHIP TO PROJECT: /{;
FAX NUMBER:
❑ ARCHITECT
E] TENANT ❑ OTHER DESCRIBE):- W
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E-MAIL ADDRESS: -
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
EXISTING USE:
PROPOSED USE:
PRINKLERED BUILDING?
ATER SERVICE PROVIDER:
NER SERVICE PROVIDER:
■ DETAILED BUILDING INFORMATION
EXISTING BUILDING ASSESSED/APPRAISED VALUATION
❑ YES ❑ NO
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: $
■ PR03ECT FLOOR AREAS
FLOOR
EXISTING S . FT.
PROPOSED S . FT.
TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
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)
BOILERS)
FIREPLACEINSERT(S)
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 FOUNTAIN(S)
SHOWER(S)
WASH MACHINE OUTLET
GAS PIPE OUTLET(S)
SINK(S)
WATER CLOSET(S)
MISC. ( )
INTERCEPTOR(S)
SUMP(S)
DISCLAIMER/SIGNATURE13LOCK
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 whe# such claim arises out of a reliance of the city, including its officers and employees, upon the accuracy
of the inform ation,cwpplieo the citA as a par af-application.
NAME/TITLE:
❑ PROPERTY OW ❑ APOLICANT El CONTRACTOR
FOR OFFICE USE ONLY
DATE: -I 7 U
❑ 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 • 253-661-4000 - FAX: 253-661-•/