02-105087 I --;,���
� � CONSTRUCTION PERMIT APPLICATION�
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� E�E!"ZAL � � 2OOZ pp�Cq�ON NUMBER: '
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� � ��pERA�WA� PPLICATION NUMBER: — — _ — — — — — — _ — —
,���O P�• PPLICATION NUMBER: _ _
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� **The following is required information-Please print(in ink)or type**
I Please note: Eledrical,Fire Prevention Systems and Engineering permits may require a separate application.
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' SITE ADDRESS� / v /S � �v� � � ASSESSOR'S TAX/PARCEL #: -
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LEGAL DESCRIPTION SUBJECT PROP RTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
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• . . • .
TYPE OF PROJECT(This application): �BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): ��/'Zal��� •G'�--fJ'T-sr-G
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PROJECT NAME: C�%/�(�A'C �/U��C � /�G/�jiU�QrG
• • • � •
PROPERTY OWNER: N^ME: _ DAYfIME PHONE:
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MAIL[NG ADDRESS(STREET ADDRESS;CITY,STA7E,ZIP):
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CONTRACTOR: NAME:
DAYTIME PHONE:
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MAIUNG ADDRESS(STREET ADDRE55;CIfY,STATE,ZIP): EVENING PHONE:
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CITY OF FEDERAL WAY BUSINE55 LICENSE NUMBER: FAX NUMBER:
— � �
CONiRACTOR'S REGISTRATION NUMBER: IXPIRATION DATE:
(topy of card nequired) � �
APPLICANT: NAME: DAYTIME PNONE:
f'�"c+�G' e�i�.�.-�,� c i�� (�f3 )S-9/ -e�d 3.�
MAIUNG ADDRESS(STREET ADD S;CSfY,STATE,ZIP):
EVENING PHONE:
/ � J'd , �'J�`` �S'�/L�7— ;qc-,,�,.r ��, ( ) -
RELATIONSIIIP TO PROJECT: FAX NUMBER: /
. ❑ ARCHITECT ❑TENANT �OTHER(DESCRIBE):O�"'�� �,r� �O f -p 47�
E-MAIL ADDRESS:
CO(VTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER `�APPLICANT• ❑ CONTRACTOR
. . : . . - •
EXISTING USE:/�6 ��I�-T?/�C- EXISTING BUILDING ASSESSEU/APPRAISED VALUATION �
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PROPOSED USE: f�/"1� • PROPOSED VALUATION FOR IMPROVEMENTS: ;oZ 60�OG U. �-
SPRINKLERED BUILDING? �YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES �NO
WATER SERVICE PROVIDER: �,IAKENAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: �LAKENAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
'�"NEW RESIDENTIALCONSTRUCTIOI Y'*
NUME3ER OF E3EDROOMS: ESTIMATED SELLING PRICE: $
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• • • • • • � � • �
FLOOR EXISTING S .FT. PROPOSED S .FT. TOTAL
BASEMENT
FI RST
SECOND
THIRD I
�
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) +
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) , FURNACE(S) '
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING I
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.( )
IfYTERCEPTOR(S) SUMP(S)
. •
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowiedge,and
furti�er,that I am authorized by the owner of the above premises to perform the woric for which the permit application is made. I
further agree to hold harmless the City of Federal Way as to any claim(induding costs,expenses,and attomeys'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 su aim arises out of the reliance of the city,induding its officers and employees,upon tfie accuracy
of tfie information supplied to 'ty as a part of this application.
NAME/TITLE: // DATE: �� /� O a
�PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
*�FORQFFICE;.USEONLY :::
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COMMUNifY DEVELppME►JT SEFtyICES•33530 FIRST WAY SOUTti•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253�61-4000•FAX:253-661-4129
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