99-104569 BUILDING DIVISION
crri;oC � ';� ` \�' `Li 33530 First Way South
VV — Federal Way,WA 98003F T FTY
(253)661-4000
Fax(253)661-4129
•
Cil e , , .. ,uHY '9./1)95.69
[3U i l-U 'v DEPT.
APPLICATION FOR BUILDING PIF : . T
/ s� - C
PLEASE PRINT ,PPLICA i -72._
> i Site`: : ••. >�>> >»<>':`»�> <<':: >:>:>: >...., address - 43
Tenant name Lot# essor's Tax#
/N / KF let iN6',11 0 iNI ,
Building Owner's Name A*ess
/N //le /(4L/& C,YIAN . A 2 / i 0 ^ I
City :7 (A.) • State rJ�l7] Zip •�0 I Phone-/VI"it 17
Description of Work c G"F ritigrnf
Name (F,M,L)
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Address 0(1/0 .S, 3 /
r 9 i�-''�''y—
city , JAI • • 1::/ Zip 116003 .
Contact Person Day Ph. - i • — 'ne Fax
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��.................:.:.Tf3AOTOR.:::::::::;::::.::.::�::.;:�;,:.�;: � F a usiness License #
Company Name _ �' V� '
Address 1'
City ♦ State Zip
NIL4k‘te
Contact Person Phone Fax
Contractor's # (card must b N ) Expiration Date Verified 0 Yes IDNo
} ARClitTEMiiiiiiiiiia:. ..ii:ii:.. .i:::::rii::-. ..,,Ki:
Name /
L pi - CIA cXA64 ,
Address ,
%.17
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,
City £Dc>�A� StateIA'T7 Zip 960031
Contact Person Phone Fax
G ',a— 947—!Jo1 -
'.LEGAL DESCRIPTI•
Please Complete Reverse Side
tf i
XlStln USe ,.
_ UC.Ti,�aE : > � g i a� 9�-- !Proposed Use >�r�L
Permit includes: Building ❑ Plumbing 0 Mechanical 0 Other
Type of Work: l, Residential ID New 0 Remodel ❑ #of bedrooms 0 Deck
0 Commercial ❑ Addition 0 Repair \ Garage 0 Shed
—
Enter 1st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft
Area Basement s ft Decks sq ft Garage .. sq ft Proposed Total Area sq ft
'Water Availability5,�-r Availability 0 On-Site Septic System Availability Project Valuation SEI/w,00.
;
Zoning .. " Jr f '''% I Lot Size r 4/i'mit£ Existing Bldg Valuation $
gEM..... ��:-�:>:::;�:>:::::.:..�.�• ��.iw>:.: >,::¢ ::••;•. For new residential /y- Proposed selling cost: $
Name , r
Address
s
City '-, State I Zip
$114*AritiCAttainagiatintaignia 41. i .,,... .
Contractor Name Address
City • a. State Zip
Contact Phone Fax
License # 0 :,. f• :. ,:.', 1,"
Expiration Date Verified 0 Yes 0 No
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Contractor Name •i .a " . Address
4 .,-
City ate Zip
Contact phone Fax
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License # yation Date• Verified 0 Yes C7 No
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LUMBiN 1X1 RE;; f UN .:::.: .:.:: .::::::. �'` tilt
Water Closets Sinks 'l Urinals ,' Mt Lawn Sprinklers
Bathtubs Dish Was.-rs Drinking Fountains . Other
11
Showers Electri• ater Heaters Sumps
Lavatories Was ing Machine Drains 44 iota te'count . ..
1,
MECHANICAILUNitdOUNTE MECHANICAL EVALUATI Y $
Fuel Type (gas/electric/other) Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons
Length of Gas Piping Range Air Handling > = 10,000 CFM 30-50 Tons
Furn <100K BTUs Gas Log Unit Heater 50+ Tons
Furn >100 BTUs Fans Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers Above Ground
Cony Burner Duct ork 0-3 Tons Underground
BBQ's
Woo
d Stoves -
3 15 Tons
Total 13ftiGt�ttri << :'. ><<>z``>
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 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 supplied to the city as a part of this applicatk.
:J. xii....,r,..,..‘SOwner/Agent: ?a Date: /2/i411
11[VG(o 5/1 0/99