02-101616 ��_-: �-, � ,
" � �� ���,������Ep CONSTRUCTION PERMIT APPLICATION
�� � PPLICATION NUMBER: Z - Q _
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PPLICATION NUMBER: - -
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�y t¢required information—Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
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SITE ADDRESS: 34424 FIRST AVENUE SOUTH ASSESSOR'S TAX/PARCEL#: 202104 ' 9 1 1 O
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): THE NW QTR OF THE
NW QTR OF THE SW QTR OF SEC 20, TWP 21N, RANGE 4E, W.M. KING COUNTY, WA
•. .• .
TYPE OF PROJECT(This application): ? BUILDING ? PLUMBING ? MECHANICAL ? DEMOLITION
? ELECTRICAL X ENGINEERING ? FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): MODIFICATION OF THE PANTHER LAKE ELEMENTARY SCHOOL PARKING
LOT TO SEPARATE BUS TRAFFIC FROM PARENT TRAFFIC,CREATE ADDITIONAL PARKING,AND ENHANCE STUDENT SAFETY.
PRo�Ecr NaMe: PANTHER LAKE ELEMENTARY SCHOOL BUS SEPARATION PROJECT
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PROPERTY OWNER' NAME: DAYfIME PHONE:
� FEDERAL WAY SCHOOL DISTRICT ( 253 )945 -5930
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
1066 SOUTH 320T"STREET,FEDERAL WAY,WA 98003
CONTRACTOR' NAME: DAYTIME PHONE:
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MAILING ADDRE55(S7REET ADDRESS;CIiY,STATE,ZIP): EVENING PHONE:
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CITY OF FEDERAL WAY BUSINE55 LICENSE NUMBER: FAX NUMBER:
- - � � -
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) / �
APPLICANT' NAME: DAYTIME PHONE:
� �onald Berqstrom ( 253 ) 922-9780
DAVID EVANS AND ASSOCIATES
MAILING ADDRE55(STREET ADDRESS;CifY,STATE,ZIP): EVENING PHONE:
3700 PACIFIC HVJY EAST,SUITE 3ll FEDERAL WAY,WA 98424 � � _
RELATIONSHIP TO PRO]ECT: FAX NUMBER:
? ARCHITECT ? TENANT X OTHER(DESCRIBE): ENGINEER ( � -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ? PROPERTY OWNER X APPLICANT ? CONTRACTOR
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EXISTING USE: ELEMENTARY SCHOOL EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ 1,700,000
PROPOSED USE: ELEMENTARY SCHOOL PROPOSED VALUATION FOR IMPROVEMENTS: $ 150,000
SPRINKLERED BUILDING? ? YES ? NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ? YES ? NO
WATER SERVICE PROVIDER: X LAKEHAVEN ? HIGHLINE 2 TACOMA ? PRIVATE(WELL)
SEWER SERVICE PROVIDER: X LAKEHAVEN ? HIGHLINE ? PRIVATE(SEPTIC)
. **NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
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FLOOR EXISTING S .FT. PROPOSED S .Ff. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FIOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING EVAPORATIVE GAS LOG(S) REFRIG.SYSTEM(S)
UNIT(S) COOLER(S)
BBQ(5) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACEINSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ? ELECTRIC ? GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(5) �IN WATER VACUUM BREAKER(S) ? ELECTRIC ? GAS
SYS.
DRINKING SHOWER(S) VUASH MACHINE
FOUNTAIN(S) OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
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I certify under penalty of perjury that the information furnished 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 and defense of such claim),which may be made by any person,including the undersigned,and filed against the City of
Federal Way,but only where such claim arises out of the reliance of the city,including its officers and employees,upon the accuracy
of the information sup li to the "ty as a part of this application.
NAME/TITLE: � • DATE: � ZS��
? PROPERTY O ER X APPLI ? CONTRACTOR
FOR OFFICE USE ONLY:
? NEW ? ADDITION ? ALTERATION ? REPAIR ? TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION : BUILDING SHELL ONLY? ? YES ? NO
COMP PLAN DESIGNATION BASIC PLAN? ? YES ? NO
SECTION TOWNSHIP RANGE NEW ADDRE55 REQUIRED? ? YES ? NO
PLATTED LOT? ? YES ? NO CHANGE OF USE? ? YES ? NO