06-102431 . � `
�� CONSTRUCTION PERMIT APPLICATION
CITY OF �� ��C�IVED PPLICATION NUMBER: - d2 - Q
Federal Way PP��noN N�MBER: _ _ - _ _ - _
�pY 1 6 2006 Pp���ON NUMBER: - -
*'�Th��ql�p�kn�.�r�q�u�iL wAiormation-P�ease print(in ink)or type*' �, tOl�
� Please note: Electrical, Fire�����.,ms and Engineering permitr may require a sepa�ate application. l �1 -�
. � . � . �
� SITE ADDRESS: 3a�lp'� ( I St (��1•�A2L.�p S . ASSESSOR'S TAX/PARCEL #: -
j LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
��
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• • • • •
fTYPE OF PROJECT(This application): o BUILDING o PLUMBING a MECHANICAL ❑ DEMOLITION
� o ELECTRICAL o ENGINEERING �FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): �}�S"�G�� �(,�fi �1 p�^ � y��� --�1A�.�a,-�r,�
`Q . � G-���..l.c>-n � r P_ ��l 7��Y� r�e S� (CTYI i���
; PROJECT NAME: � �
• • • • •
PROPERTY OWNER: NAME: ; DAYfIME CHONE:
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MAIIING ADDRESS(STREET ADDRESS;CCTY,STATE,ZIP):
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CONTRACTOR: NAME: ; DAYTIME PHONc: �
�_�-T rtoc.�c,�. o-�� �uc� �e�r u ;c�s ` c�Ul� ) �-a(�O - o��-+ v�
I MAILING AODRESS(STREET ADDRESS;CITY,STATE.ZIP): . EVENING PHONE� �
; c.�i oc� , a� C�,v-c.. S vu�-►�, � ( ) - i
CITY OF FEDERAI WAY BUSINE55 LICENSE NUMBER: , FAX NUMBER: 1
t � - � �, � 0 5 5' - g � I (aoc�) -�-��-- acn� �-�
CONTRACTOR'S REGISTRATION NUMBER: � DCpIRATION DATE:
� (mPy M card required) �,� 1 � V d � � lL �L C1 Q L � ( c�-� ' � �o�Q�
APPLICANT: NAME: DAYTIME�HONE: �
� l I_e, �1 Y1� �A 70 � I � � i
4 I MAILING ADDRESS(STREEf AO�URESS;CITY,STATE,ZIP): i EVENING PHONE�
(• � 3a-�t �-� � 5� a �-�-�--r, ; ( ; - I
! RELATiONSHIP TO PROJEC�: �
f" I ; FqX NUMB:R: :
�l � ARCHITECT ❑ TENANT O OTHER(DESCRIBE): . � � - !
I
I I E-MAI�ADDRESS: I
� I �
, CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER o APPIICANT �CONTRACTOR �
I
� � � : � • • •
EXISTING USE: �,���'��-'� EXISTING BUILDING ASSESSED/APPRAISED VALUATION �
PR D USE: \�GS�'�'fGwwv� PROPOSED VALUATION FOR IMPROVEMENTS: �__I��O _ C9'O
PRINKLERED BUILDING? ❑ YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: YES a NO
' WATER SERVICE P VIDER: t�LAKEHAVEN ❑ HIGHLINE o TACOMA O PRIVATE(WELL)
SEWER SERVICE PROVIDER: �IAKEHAVEN ❑ HIGHLINE Ci PRIVATE(SEPTIC)
�*NEW RESIDENTIAL CONSiRUCTION ON "�
NUMBER OF BEOROOMS: ESTIMATED SELLING PRICE: #
• • • • •
FLOOR EXISTING S .FT. PROPOSED S .FT. TOTAL
SASEMENT
FIRST
I
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRZBE) �
1
i
DECK
I
GARAGE
HOW MANY FLOORS?
�
TOTAL: i
Indicate number of each type of fixture
MECHANICAI Value of Mechanical Work: $
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(5)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUNiBY(dG
BATNTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC o GAS
DRINfQNG FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSEi(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
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I certify under penaity of pe�jury that the information furnished by me is true and oorrect to the best of my knowledge,and
furtfier,that I am authorized by the owner of the above premises to perfortn the work for which the permit application is made. I
furthe�agree to hold hartnless the City of Federal Way as to any daim(inciuding costs,expenses,and attorneys'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
Federai Way,but oniy where such claim arises out of the reiiance of the aty,induding its officers and employees,upon the accuracy
of tfie(nformation supplied to tfie city as a part of this appiication.
NAME/TITLE: - ��` l.(70/ �DATE: _ �/�� ��
❑ PROPERTY OWNER ❑ APPLICANT O RACTOR
�
-,FOR_OFFICE USE ONLY ;�
�.�;� .�.:� . :t �.:, , ..�.�_� .,.,_.,� �,��
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'�„;NEW����`p ADDITION ��T�:[!ALTERATION�-�=�,o.REPAIR��..���,.TENANTIMPROVEh1ENT�,�';��r ... �
'CENSUS CODE���.��rr'.���>.�;,�.'` .��.��.�t���� ��LOT SIZE ��'�-���'�,���,,��„�Y�`:<;'�x �: °.��. - I
'ZONING DESIGNATION, '�.��� �'p_�.r�����,;�,�,�,.�kBUILDING,iSHELi.'ONLY?a O;YES�`�:� NO' '' �
-COMP PLAN DESIGN%1TIUN s .�,,: �^ '� k ��e'� ry"'� � '
, �-. ...,.
. „ _ ,=�,:.� r�--�;.. �BASIC PLAN2 �YES .'O NO�_ , � ,..:; . �:.,�
SECTION�b� -,;�aTOVYNSHIP_w.,', 'RANGE` �� . .NEW ADDREBS RE' UIRED?, _. "� �: o'YES� �o NO �, �
��< � �"� ='���:~� CNAN6E OF USE? �" "'❑YES=`'�=fl'NO.
,; ,,, .. w ; !
�PL'ATTED'LOT? �,=o YES .'-,o NO; . �=� Y ;. . ... � _ .
COMMUNCfY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAI WAY,WA 98063-9718•253�61-4000•FAX:253�61-4129
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