03-101012 ` CONSTRUC N PERMIT APPLICATION
CITY OF �..i ppLICATION NUMBER: - � - �
Federal Way PPLICATION NUMBER: _ _ - _ _ _ -
PPLICATION NUMBER: - -
*"The following is required informa�ion—Piease print(in ink)or type*' � �j�� � L�
Please note: Eledrical, Fire Prevention Systems and Engineering permits may require a separate application.
• •
SI DD SS: E 5 'S TAX/PARC #
LE ES O SUB P F TY(A PA E DE I�GT
• • • • •
TYPE OF PROJECT(This application): o BUILDIN6 o PLUMBIfdG ❑ MECNANICAL � DEMOLITION
❑ ELECTRICAL o ENGINEERING ❑ FIRE PREVENTION SYSTEM
PRO]ECT DESCRIPTION(Provide detailed description): e��C�O wt( }}� �r �j�S i L ��-3
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PRo�Ecr rvaMe: l.1'�'SC�Y.f/lX ���<S ��ZL.
. • . • .
PROPERTYOWNER: N^M ' � DAYTIMEGHONE�
vesc.a.� ��� ' �2ob ) 3z3 -t��st- �
MAILING ADDRESS(STREET ADDRE55;CITY,STATE,ZIP): . �
< </.Zj �oH��(s ��� 1•�. �I1ri SPk.H� Wb g�/a9 ;
CONTRACTOR: N^ME: ; DAYfIME PHONE:
[_ C�esGe w.�l-- ��e s � (zo� ) 3 t 3 - (r c f� �
I MAILING ADDRESS(STREET ADDRESS;CITY.STATE,ZIP): I EVENING PHONE� �
I '�.t� f�,�K-l-,�cs v2 N. �t� S,e ti ff� 1,ill� Jf>oS� (oZo� ) 3 z3 - `�� �
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: � FAX NUMBER: I
- - I (�o� ) 3z -G�� L �
CONTRAC70R'S REGISTRATION NUMBER: � DCpIRATION DATE:
CroPY of card required) i � /
APPLICANT: NAME: DAYTIME�HONE: �
,�� ek�PS�.,J � bas3 ) s'�f - ���z5 �
MAILING ADDRE55(S7REET DRESS;CITY,STATE,ZIP): f EVENING PHONE�
� �ZS d�0 vl�i�t.fS QVQ �t1. 7t 1 L� SQ 4 kY� W 4F Q�1 a/ I ���j % �'(o l� -7S 7 f I
� RELATIONSHIP TO 7ROJECT: r7 i FAX NUMBER:
❑ ARCHITECT ❑TENANT �(OTHER(DESCRIBE): Y✓�jCC�� I�(4�c�.�,Qv i �j�, � 3�3 -�?G Z �
; E-MAIL ADDRESS: -�
CONTACT PERSON FOR THIS PROJECT: O PROPERTY OWNER �APPLICANT ❑ CONTRACTOR � �
r . . • • •
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION ;
PROPOSEDUSE:5��t1�C -l'Y�+-r.�1 �S��ktSL— PROPOSEDVAtUATIONFORIMPROVEMENTS: $
SPRINKLERED BUILDING? o YES a.RNO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:o YES +�NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN o HIGHLYNE o TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: o LAKEHAVEN D HIGHLINE o PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ON
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: #
• • • • •
FLOOR �QSTING .FT. PROPOSED S .FT. TOTAL
BASEMENT
f✓C�- �} ----`
FIRST
N p �3 0 /�30
SECOND � / �,r��
A '"� - �
THIRD �, � ! ,. � �J r� ` •s �:, � .
u
FOURTN , • - �' . f �" ' -
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�' � ,- ,�/✓A,,u�* N . ---,
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OTHEf2,FLOOFtS��DESCRIB� * " � k � N/� � � :' .�
'� [�EtK' . s' �a . , -•� ,�� � w. ��` �c�o, :�`:. * . �
Cp'vQvQ,Q � �rc�=� � ?1 �
GARAGE d CQr
HOW MANY FLOORS? �F� 7G � 7��'
TOTAL: -'� -�� � a7��
Indicate numbe�of each type of fixture
MECHANICAL
AIR HANDLING UNIT(5) �_ EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) 5 FAN(S) � HOOD(S) WOODSTOVE(S)
BOILER(S) � FIREPLACE INSERT(S) _l_ RANGE(S) MISC.( 1
COMPRESSOR(S) �— FURNACE(S)
� DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC �-GAS
PLUMBYNG
oZ BATHTUB(S) � LAVATORY(S) URINAL(S) � WATER HEATER(S)
I DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC �GAS
DRINfQNG FOUNTAIN(S) SHOWER(S) I WASH MACHINE OUTLET
GAS PIPE OUTLET(S) � SINK(S) �_ WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
. •
I certify under penalty of pe�jury that the information furnished by me Is true and correct to the best of my knowledge,and
furtfier,that I am autho�ized by the owner of the above premises to perform the worfc for which the permit application is made. I
furtfier agree to hold hartnless 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 claim arises out of the reliance of the aty,induding its officers and employees,upon the accuracy
of the information supplied to the city as a part of this appiication.
NAME/TITLE: �_e��,�'s''" DATE: � O'3
❑ PROPERTY OWNER ❑APPLICANT ❑CONTRACTOR
_ __ _ _ _.
_.FOR.OFFICE.USE ONLY.;�;''
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CENSUS`CODE�.�����=�� �'�. ��'�LOT.SIZE:�.., �'�� .A�`���`:��:���, :�.x��- �';==�: �
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�ZONING DESIGNATION .;�����'�,����` ��BUIIDING:6HELL�ONLY?.��o.YES�.,,o NO „ � ,;. ,,. �
,COMP PLAN DESI6NATION � �; „ ��'���b�:-�,.�� �,BI45IC,PLAN?��°o YES ,,,��Io.NO,r�'�,„, �-�-�-
:�ECTION�� -��TOWNSHIP �k� RANGE����, �NEINADDRESSRE UIRED?`�� �-�:o�YES � �n,IVO., T
'PLA7TEU;LOT? �,��o YES�;„o<NO x���'�` ��::��#� xCHl►N6E OF USE?;`���, ' ;n YES��"�-❑ NO s� s
COMMUNITY OEVELOPMENT SERVICES•33530 FIRST WAY SOU7N•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253�61�000•FAX:253�61-4129
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