01-102816 � �,;��:�,��--�::�
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«n� G CONSTRUCTION PERMIT APPLICATION
'� ��— PPLICATION NUMBER: Q j — O Z Q L — CQ
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PPLICATION NUMBER: — —
��s � `:'� �.''�`,�—Yv'�`� PPLICATION NUMBER: — — - — — - — — — — — —
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**The following is required information—Please print(in ink)or type**
Please note: Electricai,Fire Prevention Systems and Engineering permits may require a separate application.
. . • . • .
SITE ADDRESS: �� � ASSESSOR'S TAX/PARCEL#:� �O �..5� 'O���6
LEGAL DESCRIPTION OF SUB7ECT P OPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
�_/7 6���
• • • • •
TYPE OF PROJECT(This application): �UILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PRO]ECT DESCRIPTION(Provide detailed description): � O � ��
62,�Z S� �G���D11S/l+�G �'G,�L �f/GES o/� ��- 2- �� �hS
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I�M t T �4-N�t 0 T � / S S � F O I w ✓�
PRO7�CT NAME:
• • • • •
PROPERTY OWNER' NAME: � � �� �AYTIME PHONE: _
� S �' �
MAILING ADDRESS STREET ADDRESS;CTfY,STATE,IIP):
7N S• GJ
CONTRACTOR' NAME: �/��.. DAYTIME PHONE:
� S�%W�-'`N �/�/S�?�l�O/l� � ) -
MAILING ADDRE55(STREET ADDRESS;CiTY,STATE,IIP): EVENING PHONE:
22 1�S - � /v. S D ( ) -
CTTY OF FED RAL WAY BUSINE55 LICENSE NUMBER:�� _ �� � D � �� �� �AX�TM�ER: n_� �n/�
HJ � U�� !%
CONTRACTOR'S REGISTRA7ION NUMBER: IXPIRATION DATE:
� � f� L- �G � _ O 66i p i6�--
APPLICANT' NAME: DAYTIME PHONE:
� G�--l�i�'o�r ��:��I �� c 20�) 6 z3 : g .�
MAILING ADDRESS(STREEf ADDRESS; ,STATE,ZIP): EVENING PHONE:
�' � �" O .-- OJ ( ) '
RELATIONSHIP TO PROJECT: FAX NUMBER:
RCHITECT ❑TENANT ❑OTHER(DESCRIBE): � �r� 6z3 . �
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑APPLICANT ❑CONTRACTOR
. . . • • •
EXISTING USE: S EXISTING BUILDING ASSESSED/APPRAISED VALUATION # �LS�.�I�3�� Q�� �
PROPOSED USE: �• � PROPOSED VALUATION FOR IMPROVEMENTS: �
SPRINKLERED BUILDI G?�� YES NO FIRE SUPPRESSION SYSTEM PROPOS /REQUIRED�YES ❑ NO
/ \
��i�"�/�GI�Yb� a� 6 /
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WATER SERVICE PROVIDER: �6 LAKEHAVEN o HIGHLINE ❑TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ,�'CAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEP'TIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
� • • • •
FLOOR EXISTING .FT. PROPOSED S .FT. TOTAL
BASEMENT ' 2�, � 21 / 2,.�"�
� u
FIRST /
17
SECOND 2
THIRD 6 6 6 b
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:. d � 2 � ( � �7
, Indicate number of each type of fi�cture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACEINSERT(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)
. •
I certiry 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 tfie
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 o�cers and employees,upon the accuracy
of the information s plied to the city as a part of this application.
NAME/TITLE: DATE: `/ I S/O l
❑ PROPERTY O ER ❑APPLICANT ❑CONTRACTOR � ���
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