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RECEIVED
•t «,,\ FE_IZIEJKFIL_
L City of Federal Way
PUY APPLICATION FOR BUILDING PERIV
QF FEDERAL WAY
REVIEWED UNDER 1994 UBC
PLEASE PRINT APPLICATION #: Bcob- 'o a 7
I SITE LOCATION I Address (6 c/ 1 4 /z- 17/474/ ipk s LA)
Tenant(if kno n) � yl f ,�, Lot #
1 "' ' Y (2 � r) 64)N Assessor's Tax #
B ilding 0 ne, Name _ �, �� •• I S�-7 ��'c/CJ
�jU:A _A _^ . . .� T•. Address (.Y
City 6g!4- Zip -
Nature of Work �i_ [State (A �d 21 j 'phone OP?7-7— G�
f V ��
APPLICANT' I
Name (F,M,L)
Address
City
State Zip
Cony&rson I Day Phone Other Phone
Fax
!BUILDING CONTRACTOR I
Company lame
Address
City �"t--/V' 1----
State VA/ti— Zip '
Contac rs � �
c L.- t'i'G3-1 P ne F
Con tr rs # �rd mus be presented) ��` J^�
t /L ( E p' ation Date Verified ❑ Yes ❑ No
(ARCHITECT 1
Name
od /' ------
Address
City
State Zip
Contact Person
Phone Fax
('GAL DESCRIPTION
Please Complete Reverse Side
CD0492(Rev 4/93)
1
L
STRUCTURE existing Use ki S e I Proposed Use /'r '
Permit includes:
/B K
uilding Plumbing Me CI" �T Other
•
Type of Work: Residential ,i�S New '❑l Remodel El Number of Units ❑ Deck
❑ Commercial El Addition El Garage ❑ Shed ❑ Other w
Enter 1st Floor sq 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft
Area Baseme sq ft ecks sq ft Garage sq ft Proposed Total Area sq ft
Water Availabi ity Sewer Availability IN( On-Site Septic System Availability ❑ Project Valuation $
Zoning s- ,i _(' Lot Size 3% 7V y"y' Existing Bldg Valuation $
LENDER
Name / _�fr
/ ��"/
� ' Address
City / ) State /1/14- Zip / t? S
MECHANICAL CONTRACTOR
Contractor Name — Address
�-1 /1 C ` (/tie
City
State Zip
Contact
Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBING CONTRACTOR
Contractor Name) .5 77tt— t l.,uc e 1- Address
City
State Zip
Contact
Phone Fax
License it Expiration Date Verified ❑ Yes ❑ No
PLUMBING FIXTURE COUNT
Water Closets LI Sinks 1 Urinals Lawn Sprinklers_.--
Bathtubs ' Dish Washers ( Drinking Fountains ,�.130—' Other
Showers 1 Electric Water Heaters
Sumps
Lavatories `> Washing Machine Drains
—4.7-----. Total Fixture Count
MECHANICAL UNIT COUNT
Fuel Type (electric/other) fia'(''( Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons
Length of Gas Piping '7 Range Air Handling > = 10,000 CFM 30-50 Tons
t
Furn <100K BTUs Gas Log gUnit Heater 50+ Tons
Furn >100 BTUs Fans Miscellaneous Fuel Tanks
�,
Gas Hwt Hood Boilers Above Ground
Cony Burner Duct Work 0-3 Tons Underground
BBO's Wood Stoves 3-15 Tons Total Unit Count
DISCLAIMER: 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 permit application is made.I further agree to save harmless the City of Federal Way as to any claim(including costs,expenses,
and attorneys'fees incurred in inv=: '.. 'on 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 cla'•• .n .ut of he relic. •nr..,.,.,..yng its officers and employees,upon the accuracy of the information supplied to the City as a part of this
application. � --
/``y _. ., 0 j� _g
Owner/Agent: A► Da / l
,0"' te:
(II
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