03-102434 � t=� S
� ��G����� CONSTRUCTION PERMIT APPLICATION
����°`� � ��""`� PPLICATION NUMBER: - Z ,� -
��f���`c'�� �� 2003 — —
� JUN �- � PPLICATION NUMBER: - -
** P�l`4F��QE�pT AY PPLICATION NUMBER: — — - — — — — — — — —
The f�����wred information-Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
. �. � . �
SITE ADDRESSt� � �F O`�� �C�C� lyl l( �t���� �� p�ES50R'S TAX/PARCEL#:
LEGAL DESCRIPTION OF SUB7ECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHI�:
. � � . , �
TYPE OF PR07ECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERINt's'I�FIRE PREVENTION SYSTEM
PR07ECT DESCRIP'TION(Provide detailed description):�� � �'�',�I' C�C�c� �C � �4--t��_ C i 11 �����J
�--C �C.� c��'`�1 n'l(`���c���� � �-�-�.c1c�-1�- � rn ��c'���`� .
�11'��
C' _ . .� =_
PROJECT NAME: ���;`l�i�.1 .�__ , �_`- ; � ; YZ� . ,L-
• • • • •
PROPERTY OWNER: N�E� DAYTIME PHONE:
� � '
MAILiNG ADDRE55(STREET ADDRESS;UTY,$TATE,IIP):
CONTRACTOR: ruu�e; �--.
DAYTIME PHONE:
��;�� h ����� �L ���.r��� c���� i,�� -1� �:�
MAILIMG ADDRESS(STREET SS;CITY,STATE,IIP): EVENING PHONE:
� D tc ���—" /�v� ��- T��C_ ����i `i��{� ( ) -
CIfY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
1 `? - � 7 �,�,�,��-S- -O�!�� ( ) -
CANTRACTOR5 REGISTRATION NUMBER: /' IXPIRATION DATE:
���w.�����> S n� �_� r-� �- `� l �3 � � l� -r� i i
APPLICANT: N�E: � �. , _ DAYTIME PHONE:
�� ..
. �1��11-����1 1���� -_�1����E ��}'1t'-� � ��)%r�� -���'�
MAILING ADDRE55(STREET ADDRESS;�STATE, P): EVENING PHONE:
/! 0 {� �,z/-r� j��1� � �ll�� ��r ���/_�/ ( ) -
RELATIONSHIP TO PRO)ECT: FAX NUMBER:
❑ARCHITECT ❑TENANT ❑OTHER(DESCRIBE): ( � -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PR07ECT: ❑ PROPERTY OWNER ❑APPLICANT_`'�CbNTRpCTOR
• • • • •
EXISTING USE: EXIS'RNG BUILDING ASSESSED/APPRAISED VALUATION �
PROPOSED USE: PROPOSED VAIUATION FOR IMPROVEMENTS: #_ �� C�`-����
SPRINKLERED BUILDING7 ❑YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
1
**NEW RESIDEN7IAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• • • � -
FLOOR EXISTING .FT. PROPOSED .FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FIOORS(DESCRIBE)
DECK
6ARAGE
HOW MANY FLOORS7
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 o GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAI�R(S) ❑ ELECTRIC o GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
� •
I certify under penalty of peHury tfwt 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 atborneys'fees incurred in the
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 daim arises out of the reliance of N�e city,induding its off"�cers and employees,upon the axuracy
of the information supplied to the city as a part of this application.
,
NAME/TI7LE: �C'Y i ��� L I )(�(„t.�" � DATE: � I (-I C� '�>
❑ PROPERTY OWNER ❑APPLICANT o CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ADDITION ❑ALTERATION ❑ REPAIR ❑TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION: BUILDING SHELL ONLY? ❑YES o NO
COMP PLAN DESIGNATION BASIC PLAN7 ❑YES ❑NO
SECTION TOWNSHIP RANGE NEW ADDRESS RE IRED? ❑YES ❑ NO
PLA7TED LOT? ❑YES ❑ NO CHANGE aF USE7 ❑YES o NO
COMMUNIIY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-q000•FAX:253-661-4129
www.cihroffederaiway.com