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03-102401, �1`v CONSTRUCl ��N PERMIT APPLICATION� CITY OF PV ECE���� PP���ON NUMBER: - (' _ Q - Q_ Federal Wa� � PPLiCAT?4}iG NUMBER: - - , — — — — — — — — — — ' �i�N � �. Z003 Pp��+�ON NUMBER: — — — — — - I i � *�The followin is required information—Please print(in ink)or type'�' `��0� I � ClTY OF FEDER�L WAY Please note: ElectriQijjl��$!`K'r��f��J�Systems and Engineering permits may require a separate application. '` • s • • • � f SITE ADDRESS:����� }'"�i �/l�� S ASSESSOR'S TAX/PARCEL #: � �� �O J� - � L �� � LEGAL DESCRIPTION OF SUB7ECT PROPERTY(ATTACN SEPARATE�ESCRIPTION IF LENGTHY): I � • • • • • � TYPE OF PROJECT(This application): o BUIIDING o PL�UMBIfdG o M CHANICAL o OEMOLITION , o ELECTRICAL o ENGINEERING FIRE PREVENTION SYSTEM PROJECT DESCRRIPTION(Provide detailed description( ):��n ` �� �.%�`�` ! ��'-� �/ ^ �� ;µ ^� " s' �^' � �, � ( p �' i .! � _> >. � ''�:. 6'�: (F�%_ �d�'�kl. � f �f ../t�����t 1 il.� r �, f� 1(� ,.J.. . t` 1�'� . �� - � i .� � i � � ��L\�`?��� C.��\- �., I , � PROJECT NAME: �f ��i • • � • • I PROPERTY OWNER: N^ME: o ME PHONE' � � / �.Il�J � � i ��� �.'I � M. C�� �,�'�,. �� � t , ��,-,� 3�, � _ � �. 7�{ ; MAIU DDRESS(STREET ADDRE55/;�CITY,STATE,ZIP) n �� � /1 � /� r '.��j, � _� � �� � M 1�r��., /--�1��..,� ; i� ��j � �` � ���3 ( -�. `t`��s'�,I `�...4'� ,'f F/V')r( !J i ��.� " � :t t 1 CONTRACTOR: N^ME�� � � i DAYfIME PHONc: ; � <^.Y' � ` L ti ��' '` ` ' C��C_ i '��— �! _ � J� i �-• � MAILING AODRESS(STRE DDRESS;CITY,S7ATE.ZIP): ��,;..����-�. EVENI�N}G GHONE� � (/� � lJ � � � 1,�-� �� <; )1� �� � ��'.v1-1"� ;-�� - � t J I � �OF FEDERAL WAY BUSINESS UCENSE NUMBER� ` � FAX NUMBER 2� _LJ - �Q-`_�_ � - Q C� i (?.�� ) ` .; - ,'-` Iv:� i CONTRACTOR'S REGISTRATION NUMBER: /` � G........ -��'✓' ':✓•`t'�.-�� `� ,1`., � i �� r. .'* ; DCPIRATION DATE: ��,�m���,�> ;_ �= _ - i .�� � � � � � � � � APPLICANT: NAM� �'� ���f / _ ,� � �„ /_ i �AYfIME�o��� , r; � 1 ���u� �� �� ; _ �`C.�J 1�J; I i MAILIN AOORESS(STREET ADDRE 5;CITY,STATE,ZIP): I EYENING PHONE: � ��c� � l��.��� �- `"�"' `;1�- - .� ���J f' ���; :�- - � ��� ( RELATIONSHIP TO PRO7ECT: t .� /J,�,, f � � FAX NUMB R ' � O ARCHITECT p TENANT ❑ OTHER( DESCRIBE):�,�������,(� y`�^�'.�I� � ���� ] ,� ' - �� � � I ! ; E-MAIL ADDRESS: I I I CONTACT PERSON FOR TNIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR � � � : � • • • EXISTING USE: `'-� �•- EXISTING BUILDING ASSESSED/APPRAISED VALUATION ; PROPOSED USE: �{:��` PROPOSEO VALUATION FOR IMPROVEMENTS: � �O� � SPRINKLERED BUILDING? ES O NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:(9JPE5 ❑ NO WATER SERVICE PROVIDER: O LAKEHAVEN O HIGHLINE o TACOMA O PRIVATE(WELL) SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) **NEW RESIDENTIAL CONSTRUCTION ON BER OF BEDROOMS: ES7IMATED SELLING PRICE:• � NUM � � • • • • � FLOOR DCISTING S .FT. PROPOSED S .FT. TOTAL � BASENIENT � FIRST � SECOND � THIRD FOURTH OTHER FLOORS(DESCRIBE) ' DECK � GARAGE � HOW MANY FLOORS? TOTAL: � , . Indicate number of each type of fixture i MECHANICAL � AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S) � BBQ(S) FAN(5) HOOD(S) WOODSTOVE(S) BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( ) � COMPRESSOR(S) FURNACE(S) DUCT(S) GAS PIPE OUTIET(S) HEAT SOURCE: ❑ ELECTRIC o GAS PLUNiBY1VG I BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S) ! DISHWASNER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELEGTRIC ❑ GAS DRINFQNG FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( ) INTERCEPTOR(S) SUMP(S) . • I certify unde�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 authocized by the owner of the above premises to pei-form the woric for which the permit application is made. I furtfier agree to hold harmless the City of Federal Way as to any daim(induding costs,expe�ses,and attorneys'fees incurced in the iavestigation and defense o such daim),which may be made by any person,induding the undersigned,and filed against the City of Federal Way,but only wh such claim a ses out of the reliance of the city,including its officers and employees,upon the accuracy of the(nformation suppli o the aty a rt of this appiication. NAME/TITLE: DATE: C.2 �� � ❑ PROPERTY OWNER o APPLICANT o CONTRACTOR / �,:F.OR.OFFICE.USE;ONLY :�; e}v.�J i ��_ '.._v � : f. .- ....'t�>'_.a,.� ._..�... �,.,�o,. .A'S+,.u�. ���.+ � 3a i ...�;v.m .....".....w.:_� .v �..� ��, �:;NEW����R�ADDIfION��`�t3 ALTERATION��'�O REP.AIR�,�#�:���TENANTIMPROVEMENT��-:;,,�_k ,� , _. '-CENSUS`CODE����b-��'�;�����'"�� �LOTSIZE�'���"���.�*��`�z,�-�.,,'`�;; �,-��. tZONING�DESIGNA7ION�;����:����`�.��,�`�`� �BUILDING.StiELL'�ONLY7`�'a YES;:F.,❑�NO ,# . : ,�� � ,, , .5.., COMP�PLAIV DESIGNATIQN� -�,er ;�^:�;�,�»�k*��� �BIISIC�PLAN?��£YES �` b NO��"� �' - =SECTION`���TOWNSHIP_;��` �RANGE� ��'�"; _NEW AUURESS RE� UIRED?`„ �fy:o�YES �:� NO �� ' '�PLATTED;LOT7 �;�❑YES�o NO ,����'����'�.�� .CFIANGE UF USE7 s. .; , :a YES���-O'NO .�,'`` . COMMUNIfY DEYELOPMENT SERVICES•33530 FIRST WAY SOIJTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661�+000•FAX:253�61�129 www.dtvoffederalway.com