02-105326 � E������
' ;°' G R CONSTRUCTION PERMIT APPLICATION
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r PPLICATION NUMBER:
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G�-�(Bu`D PPLICATION NUMBER: _ _ - -
**The following is required information-Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permitr may require a separate application. l`�fl�
• . • • • .
I SITE ADDRESS: dV J�Gv �j�� _ ASSESSOR'S TAX/PARCEL#: O� [� �j ��f� �J /�
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LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
I
• • • • •
TYPE OF PROJECT(This application): BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Prov' ' a'etailed description): ���fDj�� /¢/y �,�%�`�/1� �
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� PROJECT NAME• I �J �r� �-F'.I
. • • • •
PROPERTY OWNER: N�E� DAMME PHONE:
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MAILING ADD (STREET ADORESS;QiY,STA7E,IIP):
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CONTRACTOR: N�E� � i UAYfIME PHONE:
GSD 5 ���G f E'iy1D�'� 1.v/LSD/f/ (;Zt3)7Y0 —y4°13
MAILING ADDRESS(SfREET ADDRESS; ,STATE,ZIP): EVENING PHONE:
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CTfY OF FEOERAL WAY BUSINESS UCENSE NUMBER: FAX NUMBER:
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CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION OATE'
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APPLICANT: NM1E:
DAYTIME PHONE:
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MAIUNG ADORESS(Sl'F2EET ADDRESS;QTY,STATE,ZIP): EVENING PfIONE:
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RftATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT OTHER(DESCRIBE):_CC�����OIZ � � -
E-MAIL AOORESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER �APPUCANT �CONTRACTOR
. . . • • •
EXISTING USE: �i.�j%���L EXISTING BUILDING ASSESSED/APPRAISED VALUATION �
PROPOSED USE: L�D������ PROPOSED VAIUATION FOR IMPROVEMENTS: � ��, 0rd[d
SPRINKLEREO BUILDING? ❑ YES I�NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES �NO
WATER SERVICE PROVIDER: �LAKENAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRNATE(WELL)
SEWER SERVICE PROVIDER: �LAKENAVEN ❑ HIGNUNE ❑ PRIVATE(SEPTIC)
*'�P1EW RESIDENTIAL CONSTRUCTIQN"NLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PI : $
• • . • •
FLOOR EXISTING S .FT. PROPOSED S .FT. TOTAL �
BASEMENT
FIRST
SECOND
THIRD
FOURTH �
OTHER FLOORS(DESCRIBE)
DECK
i
GARAGE �� ��
HOW MANY FLOORS?
TOTAL:
Indicate number of each type of fixture
MECHAN L
AIR HANDLING UNIT(S) EVAPO TIVE COOLER ) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) F N(S) HOOD(S) WOODSTOVE(S)
BOILER(S) REPLA E INSERT(S RANGE(S) MISC.( �
COMPRESSOR(S) RNAC S)
DUGT(S) PIPE UTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PL MBI G
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEA7ER(S)
DISHWASHER(S) RAIN WATER SYS VACUUM BREAKER(S) ❑ ELEGTRIC ❑ GAS
DRINIQNG FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET �
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) S MP(S) �
� • • . • �
I certify under pe�alty of perjury that the informaiion fumished by me is true and rnrrect to the best of my knowledge,and �
furtt�er,tfiat I am autfiorized 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 C'ity of Federal Way as to any daim(induding costs,expenses,and attorneys'fees incurred i�tfie ,
investigation and defense of such daim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but onl ere such daim arises out of tfie reliance of the city,induding its officers and employees,upo�the accuracy
of tfie inforrnatio uppl d to the dty as a par�of is application.
NAME/TITLE: DATE: �/�'�(/�—� �
❑ PROPERTY OWNER ❑ APPLICANT �CONTRACTOR
�FOR OFFICE USE ON[1( I� �OI O �jt.l'�+Q,�1 L �O�c� � 3I D �I(��S
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❑ ADD ALTERATION: � REP R :� TENANT IMP OVEMENT�.�-�. :
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OOMMUNITY DEVELOPMENT SERV[CES•33530 FIRSf WAY SOUTI i•PO BOX 9718•FEDERA(.WAY,WA 98063�9718•253-1i61-4000•FAX:253�i61-4129
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