03-100425 f
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� ` CONSTRUCII�,N ERMIT APPLICATION
CITY OF �"�..� ������i�t�.-�_i PPLICAIION NUMBER: � � - C o c� �- 2 � oo FP
Federal Way PPLICATION NUMBER: - -
,y��a � E's _ PPLICATION NUMBER: _ — — — — — - — —
*'�The followiny�is S��q�ir��information-Please print(in ink)or type*'
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Please note: Eledri�A�;F���pc�3i�L`+ui�"Systems and Engineering permits may require a separate application.
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SITE ADDRESS: .�� 5�` �>� �/pf.}i�•_ /�w�/y�E�SOR 5 TAX/PARCEL #: t _' � � Z O- 4(� Z �
/ —
LEGAL DESCRIPTION OF SUB]ECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
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l TYPE OF PROJECT(This application): o BUILDING D PL�fMBIf�G ❑ MECHANICAL o DEMOLITION
` ❑ ELECTRICAL ❑ ENGINEERING�`FIRE PREVENTION SYSTEM
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PROJECT DESCRIPTION(Provide detailed description): /��� � ����� � .�J�7 ` 5�,��� ��
� PRO7ECT NAME: �j7/��/�/C� �j�/,�'�(�J�i �GC�� �
• • � • •
Pf20PERTY OWNER: ` �+^ME , �- G ; �Ar,1ME vHONE
�fC �%//'Zl '+�- -� cf� fi�C!J /�/� � i ) - '
MAILING ADDRE55(STREET ADDRE55;C1lY,STATE,ZIP): I
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CONTRACTOR: � NaME� . � DAYTIME PHONc: I
i �Fjtt d �v�ff�i� �L�'R,�L1.�Go� � (�G:n } �;�'3 - 3307 �
I MAILING ADDRESS(STREET ADDRESS;CITY,STATE ZIP)� EVEN[NG PNONE' �
� .2'�� .�/iJl'./t- 1i9.�� �fv�/. �m�✓X�G� N/.�l ; � (3G� ) �/ - �lr i/ i
CITY OF FEDERAL WAY BUSINE55 LICENSE NUMBER: , PAX NUMBER:
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CONTRACTOR'S REGIS-TRATION NUMBER:
��/- /� s_� 1 � IXPIRATION OATE:
(copy of prd required) I � ��� '✓�!(J V� I % �
APPLICANT: NAME: • �AvnME vHONE'
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I MAIUNG ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): I EVENING PHONE: i
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I RELATIONSHIP TO PRO)ECT: i FAX NUMBER: '
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l ❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE): � � � - I
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j E-MAIL ADDRESS: I
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER o APPLICANT ❑ CONTRACTOR � I
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EXISTING USE: ."����'='l�h-�'�� EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: ,5���/ PROPOSED VAIUATION FOR IMPROVEMENTS: $ `J-�n ��
SPRINKLERED BUILDING? o YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSE�/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE o TACOMA p PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN n HIGHLINE � PRIVATE(SEPTIC)
•*NEW RESIDENTIALCOfKSTRU�N LY** !
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NUMBER OF BEDROOMS: ESTIMATEO SELLING PRI__. �
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FLOOR EXISTING S .FT. PROPOSED S .FZ'. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
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Indicate number of eact�type of fixture
MECHANICAL �
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(5)
BOILER(S) FIREPLACEINSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑GAS
PIUNiBYfdG
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISNWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(5) SUMP(S)
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I certify u�der penalty of perjury that the infonnation furnlshed by me is trve and oorrect to the best of my knowledge,and
furt�e�,that I am autfiorized by the owner of the above premises to perfortn the work for which the permit application is made. I
furtfie�agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,a�d attorneys'fees tncurred in the
investigation and defense of such daim),which may be made by a�y person,induding the u�dersigned,and filed against the City of
Federal Way,but only where such claim arises out of the reliance of the dty,including its officers and employees,upon the accuracy
of the information supplied to the d as a pa of this application.
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NAME/TITLE: � DATE: / .�n y '"V
❑ PROPE OWNER ❑ APPLI NT ❑ OR
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_FOR OFFICE USE ONLY:. i
�<� K� 4- �; _ =, ` ❑TENANT IMPROVEMENT`"` ''
� NEW.:; :;p ADDITION -o ALTERATION ,. .'o REPAIR
CENSUS�'CODE:�-_.. _.x � ��� � �LOTSIZE: ,-- � .- -' ` ,
'ZONING;DESIGNATION�'� - .` =BUILDING SHELL`ONLY?"��[n YES��'S ❑�'�NO �
COMP PLAN DESIGNATION � ' � � , BASIC PLAN? � '',� YES ' ` ❑ NO '°'= ` ,
SECTION „w - �TOWNSHIP 'RANGE= ., = 'NEW ADDRESS RE UIRED7 ''•. ❑YES • a N0
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PLATTED LOT?. '.`a YES a'NO ."" -'s= : CHANGE OF USE? '. . - ❑:YES"`�n'NO : � "
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERA�WAY,WA 98063-9718•253�61-4000•FAX:253�i61-4129
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