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
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� *�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.
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SITE ADDRESS:����� }'"�i �/l�� S ASSESSOR'S TAX/PARCEL #: � �� �O J� - � L ��
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LEGAL DESCRIPTION OF SUB7ECT PROPERTY(ATTACN SEPARATE�ESCRIPTION IF LENGTHY):
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� • • • • •
� 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' �^'
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PROJECT NAME: �f ��i
• • � • •
I PROPERTY OWNER: N^ME: o ME PHONE' �
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M. C�� �,�'�,. �� � t , ��,-,� 3�, � _ � �. 7�{ ;
MAIU DDRESS(STREET ADDRE55/;�CITY,STATE,ZIP) n �� � /1 � /� r '.��j,
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CONTRACTOR: N^ME�� � � i DAYfIME PHONc: ;
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� 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���
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MAILIN AOORESS(STREET ADDRE 5;CITY,STATE,ZIP): I EYENING PHONE:
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( RELATIONSHIP TO PRO7ECT: t .� /J,�,, f � � FAX NUMB R '
� O ARCHITECT p TENANT ❑ OTHER( DESCRIBE):�,�������,(� y`�^�'.�I� � ���� ] ,� ' - �� � � I
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; E-MAIL ADDRESS: I
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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
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COMP�PLAIV DESIGNATIQN� -�,er ;�^:�;�,�»�k*��� �BIISIC�PLAN?��£YES �` b NO��"� �' -
=SECTION`���TOWNSHIP_;��` �RANGE� ��'�"; _NEW AUURESS RE� UIRED?`„ �fy:o�YES �:� NO �� '
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COMMUNIfY DEYELOPMENT SERVICES•33530 FIRST WAY SOIJTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661�+000•FAX:253�61�129
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