02-104017 • 0
°� _ CONSTRUCTION PERMIT APPLICATION
VV F3Y L RECEIVED APPLICATION NUMBER: 0;2-- IQ q 0 n
SEP 1 7 APPLICATION NUMBER: -
2002
APPLICATION NUMBER:.__ _ - _ _ - _
*Ogg t ole ,Ae9giftt information-Please print(in ink)or type** •
BUILDING DEPT.
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
�- � ■ PROPERTY INFORMATION •
SITE ADDRESS: .y�`O `Ck-S ) J€J . ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
-- - l•.• PROJECT INFORMATION , . - . ... - - -
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
El ELECTRICAL ❑ ENGINEERINCKFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): ' P� - ` r.e- k,J c.� &Y.-AA( t&
3k- ,A.0.1/44.- ► - ....2. ► 0 . Cc �..,e_ c,,,c1 IA rt G�r a., f)riH \
PROJECT NAME: Z>li- G. C
. . - ■ PEOPLE INFORMATION -
T_
PROPERTY OWNER: NAME: DAYTIME PHONE:
( ) -
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: NAME C �\� \ DAYTIME PHONE:
C,pV\40E L �%\! 5� (2-4m.)2-34. - S1
MAILING ADDRESS(STREET ADDR CITY,STATE,ZIP): EVENING PHONE:
Zos , - 5 2 ck- cMc3" 2 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
( )
CONTRACTOR'S REGISTRATION NUMBER: Q EXPIRATION DATE:
(copy of card required) 5 L A -rk E -1 o a ^ kJ / /
APPLICANT: NAME:
DAYTIME PHONE:
'l--(--
MAILING ADDRESS(STREET ADDRESS;CRY,STATE,ZIP�):,t . -i Q ^`. EVENINGES)�3� - �
1 .D �O� 2 ./�-^'v� 1..0 AVL Lac ( PHONE: -
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT )OTHER(DESCRIBE):14c)ek4...J' ( )
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER PPLICANT ❑ CONTRACTOR
■ DETAILED BUILDIIING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ j 1 L' -
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES 0 NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION•Y**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• ■ PRO3ECT FLOOR AREAS •
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT •.
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL: *�
.•w ..-. v>.r.y:+..��4a.r,,.+.w•S�CeSM✓�°'Mj!*�Gf�•WMl4`AY�!V�'f'F�rURES•T��'lbS+'!Y 1.;`tN1e.:e.MY.u�q.i.r!P)A:iV+f.'!t3�'-+STftL`i3gin�•1gtfTil3mYlT!KY--MkFi+ba.
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) 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)
■'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 daim(induding costs,expenses,and attorneys'fees incurred in the
investigation and defense of such daim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the city,including its officers and employees,upon the accuracy
of the info •tion supplied to the city as a fart of this application. Gj
NAME/TITLE: ` -=,_ DATE: \ -0 2
o PROPERTY OWNER ,APPLICANT ❑ S NTRACTOR
FOR OFFICE USE ONLY:rI
=NEW .,f.; ❑,AUDITION; tea ,0 ALTERATION;4 _,._ REPAIR $❑:TENANT IMPROVEMENT
:IGEN SUS CODE ' �.:2 &', __,<_ _.._
ONING ES GNA N� v ;; n s ;.BUILDING SHELL ONLY? '0 YES.,
COMP N DESEGNATION s
�� N -� , �.ate _ �s - _ �z
TOWNSHIP RANGE ;NEW ADDRESS-REQUIRED? �` YES fl NOS
PLATTED LOT? ❑;YES NO CHANGE OF;USE? _ [I,;YES ..0-2N0 ., ,- =4$,.
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.citvoffederalway.com