02-105704 ' ��
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'` «��F � CONSTRUCTlON PERMIT APPLICATION
v ��` PPLiCATION NUMBER': �- Q,�"� b - �
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**The following is required information—Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
. � . � . �
STTE ADDRESS: �✓)�I� I��'I�i ��W�• �'��IT�' ASSESSOR'S TAX/PARCEL#: � U 2 � D� ' g L _I � "O`Q
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHI�: K(I nvr�YiD•
� • • • •
TYPE OF PR07ECT(This application): BUILDING �PLUMBING �MECHANICAL ❑ DEMOLITION
E R I YSTEM
PROJECT DESCRIPTION(Provide detailed description): �Vlll�l�b I�IUT �'�� Il�('(�(1i�Q(L YQ�lO� �r
/� �v�l (��� t��n��n��c� • TI-hs w��t, In(�,t.u�E I�J-r�.o� (��-wi�s��� ut/� ,
�� s�{yr�►s , pv�►M r���I� , �vC�rr►��.�c, P�� ��!�s r� .
PROJECT;YAME: �r"1���/�� VC/N�j �^ �/���/nl �!r/ `�' � f�Erhm r�-n�:
• • • • •
PROPERTY OWNER' NAME: n DAYTIME PHONE:
� � ��1 5r ��nrr f"I'� t �5• ( �3 ) ?�-I2 -2���
MA LING ADDRESS(STREEf ADDRE55;C1TY SfA7E,ZIP):
n•0• �i 74�7 Or1� l��i � 24°i'J -7.�0�
CONTRACTOR' NAME: DAYTIME PHONE:
, l7 � . � � -
MAILING ADDRE55(STREET ADDRESS; ,STATE,ZIP): EVENING PHONE:
l �
C1lY OF FEDERAL WAY BUSINE55 LICENSE NUMBER: FAX NUMBER:
— — � � '
CONTRACiOR'S REGISfRATION NUMBER: EXPIRATION DATE:
(copy of card required) � �
APPLICANT' NAME: DAYTIME PHONE:
� � A A��r J�nn Es /-�r��c,�,� ( Zv b )3�o°v - g 66� ���,
MQILINOG ADDRE��STREET��RE�CIfY, �,�� �� ��'�� �ENING PHONE: _
�� j'i 1-� 1
RELATIONSHIP TO PROJECT: FAX NUMBER:
ARCHITECT ❑TENANT ❑ OTHER(DESCRIBE): ( ) -
E-MAIL ADDRE55:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER �APPLICANT ❑ CONTRACTOR
. . : . • � •
EXISTING USE: � EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: I�T�li PROPOSED VALUATION FOR IMPROVEMENTS: $ �Zd� `>� -1� �
SPRINKLERED BUILDING? �YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: �LAKEHAVEN ❑ HIGHLINE ❑TACOMA ❑ PRNATE(WELL)
SEWER SERVICE PROVIDER: �LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
. �**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: #
• • • • •
FLOOR EXISTING .FT. PROPOSED S .FT. TOTAL
BASEMENT
FIRST I� `O� I I D�
SECON D
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL: I� 1�� �"I I Q�
Indicate number of each type of fixture
� MECHANICAL I(.� ( bCjl),
Il/' AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACEINSERT(S) RANGE(S) MISC.( )
� COMPRESSOR(S) " FURNACE(S)
DUCT(S) lQ• GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC �(GAS
/�
PLUMBING
BATHTUB(S) ?' LAVATORY(S) URINAL(S) I WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC �GAS
Z 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 perjury that the information fumished 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 claim(including costs,expenses,and attorneys'fees incurred in the
investigation an defe e of such claim),which may be made by any person,including the undersigned,and filed against the City of
Federal Way,bu nly ere such claim arises out of the reliance of the city,including its officers and employees,upon the accuracy
of the informatio li to the city as a part of this application.
NAME/TITLE: DATE: I�(N I�//
❑ PROPERTY O NE PPLICANT ❑ CONTRACTOR
FOR OFFICE U$E ONLY:;,
o NEW ❑ AD ON o ALTERATION '`�REPAIR ENANT IMPROYEMENT
CENSUS`CODE:" LOT SIZE:
ZONING DESIGNATION': . BUILDING SHELL ONLY? ❑YES a�VO
COMP PLAN DESIGNATiQN f►�, ' �U'I� BASIC PLAN? c�YES O
SECTIQN TQWN P ` RANGE NEW ADDRESS RE UxRED? E ❑';NO
PLATTED LOT?`' o YES o CHANGE OF USE? ❑ YES NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.cityoffederalway.com