03-101013 ` Ct7NSTRUCT J PERMIT APPLICATI N
CITY Of �../ pp�CqnON NUMBER: - � , -
Federal Way PPLICATION NUMBER: _ _ - _ _ _ -
PPLICA�ON NUMBER: - -
"The following is required informa�ion—Please print(in ink)or type*' =�33� aZ�
Piease note: Electrical, Fire Prevention Systems and Engi�eering permits may require a separate application.
. � . � . �
T DD OR'S TAX/ C ' -
ION O E PROPER CH SEP E IO�LE ):
• � � • �
TYPE OF PRO]ECT(This application): ❑ BUILDING o PLUMBING a MECHANICAL n DEMOLITION
o ELECTRICAL o ENGINEERING o FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): ��{�jw�l-�4Q �✓ �FS�L ��Ks
« ,.
a?z�a
PROJECT NAME: ���L�,aC_ (1.G� � 1 /V��C�S
• • • • •
PROPERTY OWNER: NaME: , DAYTIME�HONE:
Cv� ' �20� ) 3z 3 - 4 c S'` ;
MAILING ADORESS(STREET ADDRESS;CITY,STATE,ZIP): �
� 4a� �io��+�cs A�2 N. � lzS �24.til.a_ W�4 9Fi�� �
CONTRACTOR: N^ME: � DAYTIME PHONc:
�/Qsc.t�' �¢� � `2oto ) 3z3 '��SL ;
MAILING ADDRESS(STREET AODRE55;CIfY,STATE,ZIP): EVENING PHONE�
4Z� �j�.+►�cS �e N . ��zT S��Hk W 9 tri�s � (oZo� ) �z -l�c,a� i
C1TY OF FEDERAL WAY BUSINE55lICENSE NUMBER: � FAX NUMBER: I
- - i (.,zo� ) �Z3 - ��`z I
CONTRACTORS REGISfRATION NUMBER: � OCpIRATION OATE:
�roPY of ord required) 1 � �
APPLICANT: NAME: DAMME PHONE:
ob T��� a ' t.25� � 5�l0$ '7S7S i
MAILING ADDRE55(SIREET A RESS;CiIY,STATE,ZIP): EVENING PHONE:
I �1S �oK�'�cs f4v2 �U• � Iz� Sa�a!-1� w� 9��f i �753 % 565 _ zs'7f I
I REIATIONSHIP TO PROJECT: � I FAX NUMBER: ;
I ❑ ARCHITECT O TENANT �OTHER(DESCRIBE): ���''� 0'-(4ue,5 Qv , (�0 4 ) 3 z 3 - �7 caZ j
* i E-MAII ADDRE55: �
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER r�APPLICANT ❑ CONTRACTOR � I
. � : . • • •
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION ;
PROPOSE�USE: Si K.� � i�,(�-L_ PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES �-NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:� YES �NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE o TACOMA ❑ PRIVATE(WEIL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE o PRIVATE(SEPTIC)
I
#*NEW RESIOENTIAL CONSTRUCTION Y**
NUMBER OF BEDROOMS: ESTIMATEO SELLING PRICE: �
- • • • •
FLOOR EXISTING S .FT. PROPOSED S .Ff. TOTAL
BASEMENT �/� ��� �___,
�`� �,� / S� /lS5
SECONO �/_ / O�( ?. �� :
>-
`'� / J�r
_-� � N1a �
THIRD . � ,N� � '. - ,e
FOI��tTH - N -a3� N .
� i
OTHER FLOORS(DESCRIBE) N � -;, N/� `` „�-�-;�
x.
OECK �N . �
Co�ev�r.Q o rJ•J a �`
GARAGE 3 �✓
HOW MANYFLOORS? 02 N p ,�� 7`�J
TOTAL: �d A' 7� a 7�
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOIER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) �_ FAN(S) T HOOD(5) WOODSTOVE(S)
BOILER(S) � FIREPLACE INSERT(S) � RANGE(S) MISC.( )
COMPRESSOR(S) �_ FURNACE(S)
� DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC PS�,GAS
PLUNiBYIdG
�_ SATHTUB(S) 'i' LAVATORY(S) URINAL(S) I' WATER HEATER(S)
�_ DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC �GAS
DRINIQNG FOUNTAIN(S) / SHOWER(S) _� WASH MACHINE OUTLET
GAS PIPE OUTLET(S) _L_ SINK(S) _�_ WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
. •
I cectify u�der penalty of pe�jury that the information furnished by me(s true and correct to the best of my knowledge,and
furtf�er,that I am autho�zed by the owner of the above premises to perform the work for which the pennit application is made. I
furtfier agree to hold hartnless the Gty of Federal Way as to any ctaim(including wsts,expenses,and attorneys'fees incurred(n the
lavestigation and defense of such claim),which may be made by any person,indudi�g the undersigned,and filed against the City of
Federai Way,but only where such claim arises out of the reliance of the aty,i�duding its officers and employees,upon the accuracy
of the information supplied to the dty as a part of this application.
NAME/TITLE: DATE: � ��
❑ PROPERTY OWNER ❑APPLICANT ❑CONTRACTOR
_ _
_::FOR OFFICE;USE ONLY ,.-:.
.���., u_ .�, �.__:. , ,. v _.�.., �: ,.�:: _,:.� �� :��,� .��__,...x ,.:� �� , �;
;�p NEW;���'Y�L3 ADDITION �,.r;�.�=[3 ALTERATION'����luREP/�IR����i7'.��ENANT-3MPROVEMENT��-�„•�. x�
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,.,� ��,. � ,�°Y�;�- ��LOT:?SIZE '" ���. `....� �;���'��� ����o,. �
�CENSUS CODE:���-�r;�"'°�r�.��:�. ��."����'�� , - �� ,,.:
:ZONING DESIGNATION, �,.�`-� ��'�,��"���,, ,��BUILDING SHE�'�ONLY7�II 1fES�n N0 �;'' � ' '
�COMP_PLAN�DESIGNATION � ��,��;:"�'�` �BASICrPIAN?�'"����YES ,`�.,I[3.N0,����` �'°
:SECTIQN�*$� �,TOWNSHIP,$� ,.-RANGE���� _ NEW ADDRESSRE UIRED? �`�. :�YES.. -o N0 �� ;'
�PLATTED LOT? .:❑]fES ;=a'NO .�a���,�'��?����_, CHANGE OF USE? ���. `.-z.n YES��`-o N0 ,
COMMUNIiY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTN•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253�i61-4004•FAX:253�i61�+129
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