03-102141� ` CONSTRUCTI( PERMIT APPLICATION �
CITY OF i�"�.� ppLICATION NUMBEn: - -
Fe d e ra I Way PPLICATION NUMBER: _ _ - _ _ -
PPLICATION NUMBER: - -
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' *"The following is required information-Please prini(in ink)or type*' �� ]_
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Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application. �
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SITE AODRESS: �`O I� POICi TlL �G�wG�w S. ASSESSOR'S TAX/PARCEL #: _ _ _ _ _ _ -
� LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): �QT S VY�Q�
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TYPE OF PROJECT(This application): �(BUILDING o PLUMBItdG � MECHANICAL o DEMOLITION
O ELECTRICAL o ENGINEERING O FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): I✓15'Td1�� S�GIA� f A G�S 1 rl �Q�S�d� i � � ��b
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' PROJECTNAME: PAV1 I1b{/� CEv1T7'� � �2TS/V`A�
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PROPERTY OWNER: N^ME: ; DAv?IME�HONE: ;
� {�ar� L n�es��►�- s���es i �aoc� ��a 3- y nq 6 ;
MAIIING ADORE55(STREET ADDRESS;CifV,S7ATE,ZIG):
; 5� o t��� w�•, , S.►;4�.�'�-��b1 Se��-l�, Lv i4 9 8 t�1 ;
CONTRACTOR• NAME: L ; DAYTIME PHONe: ;
� Sun�-�T �A�-�rir�' �Gw�dl�n9 � ��ieC� }3�� � ��9� �
i MAILING ADDRE55(STREET ADDRESS;CITY,STATE.ZIP): . EVENING PHONE �
1 80�4 5 indvs-lrri�►� P1o,c.c_ 141pL�o+rt.�� Gr1�F- 3oaoi � ( ) - i
' CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: , FAX NUMBER: I
- - I ( 7n� � -9q� �
CONTRACTOR'S REGLSTRATION NUMBER: � IXPIRATION DATE:
��oPY of wrd required) i f /
APPLICANT: NAME: ,Q i pqYTIME DHONE: �
5,�. 17�ac.G.� ���. o� W�s�in �r� xct�-'� � tyo2s )y5�( - So34 �
� MAILING ADDRESS(STREEf ADDRESS;CITY,SiATE,ZIP): ; EVENING GHO
1745 I l4� � S. . Sul t�- �oZC� �t l�t��ut W� i ���u%' �'. , - Z� i
i REtATI0N5HIG TO PRO)ECT: � ��fR 1 i FAX NUMB`.R: ;
I ❑ ARCHITECT ❑ TENANT �OTHER ( DESCRIBE):C�-eri�s.I Cnr'�7N•a�,�,/ � ��,�G� � �(S� "y Sy� I
; c-MAIL ADDRESS: I
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CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER o APPLICANT CONTRACTOR L
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EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION ;
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: � � ! O� � I ��
SPRINKLERED BUILDING? ❑YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:a YES o NO
WATER SERVICE PROVIDER: o LAKEHAVEN ❑ HIGHIYNE o TACOMA ❑ PRIVATE(WELI)
SEWER SERVICE PROVIDER: o LAKEHAVEN O HIGHLINE Ci PRIVATE(SEPTIC)
**NEW RESIDENTIALCONSTRUCTION 1 •* �
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: �
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FLOOR EXISTING S .FT. PROPOSED S .FT. TOTAL
BASEMENT
FI RST
SECOND
THIRD
FOURTH
OTNER FLOORS(DESCRIBE)
DECK {
GARAGE
HOW MANY FLOORS?
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(5) !
DUGT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELEGTRIC ❑ GAS
PLUhSBYIdG
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISNWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELEGTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLEf
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
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I certify under penalty of pe�jury that the Information furnished by me is true and correct to the best of my knowledge,and
furtfier,tl�at I am authorized by the owner of the above premises to perfonn the work for which the permit application is made. I �
further agree to hold harmless the City of Federal Way as to any daim(including costs,expenses,and attorneys'fees incurred in the
investigation and defense of such claim),which may be made by any person,inciuding the undersigned,and filed against the City of �
Federal Way,but oniy where such claim arises out of the reliance of the city,including its o�cers and employees,upon the accuracy
of the information supplied to the city as a part of this application.
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NAME/TITLE: _�� '�� �),,,���('�/P��j ��N� DATE: ��Z71 C��
❑ PROPER7Y OWNER ,�APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
_�- ..-
;O"NEW -; ,_.,'p'ADDITION ❑ALTERATION . -�.'i'o REPAIR ` . ❑TENANT Ih1PROVEMENT 'Y'"
��CENSUS�CODE: ,- -� = � �LOT SIZE: - = -- �� '
'ZONING DESIGNATION: -. . ';- ' `�'', ; :BUILDING SHELL ONLY7 o'YES= :-❑ NO �
COMP.PLAN bESIGNATION =' , . ' ', :BASIC Pt1\N? =� ❑ YES -❑ NO '�
SECTION- .,� -, `,TOWNSHIP RANGE ::� �- .NEW ADDRESS.RE UIRED? _"� 'o YES � ❑ NO
'PLATTED LOT? ❑YES o�NO CHANGE OF USE? a YES' ��❑ NO
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COMMUNITY DEVELOPMEPIr SERV[CES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253�61-4129
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