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City of Federal y RECEIVED
NA9..—
' i__ APPLICATION FOR BUILDING PERMITJUN 13 1996
Oily OF FEDERAL WAY
BUILDING DEPT.
PLEASE PRINT APPLICATION #: 0 aD-
SITE LOCATION Address 7/7 S, P/n/E. fi+/LLf WAy f tr/7&/-g4 G Wicy
Ten9nt (if known) Lot /o,,, O/ a4OC./c- Assessor's Tax #
_ 17-m,a� .-<"rE /-(fccs /5' Z y Z - O/54o
Building Owner Name Address 7/7 S . MA/.fiJ6 MCI-S WAX
/-i E/✓i/ 7AA.AJ,AS'H/
City f5Oe-/L44C. I.J. State NA Zip 7dev0_3 Phone 94/- 4 317-
Nature of Work Ad VC'C - ACTEJL E',l/S7: Aots.seibmWr cot&. /ter. 4L'ALG ,/L i+//NDOW Oet` /6/6
APPLICANT'
Name (F,M,L)
,&O e4.3 Pc:-LA (LA- ..Ek
Address
5k-0 ! /V• 1244 Sr
City 7AC' rt'7/E State (N4 Zip "f se-0 (,,
Contact Person Day Phone Other Phone Fax
/2_06e/t- D6i /'-.0J A 75 2- - 2S'-f ?-
BUILDING CONTRACTOR
Company Name
/fOMe O i4.rr/er-
Address
City State Zip
Contactta Person
Ph
ffeM/C/ TA/�/S.y'A �'/f / 911 /,a:36 Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
ARCHITECT
Name
Address
City State Zip
Contact Person Phone Fax
LEGALL SiRIPTION / j /'\a� �( g
dC� llr`►Y�J C l(`
1.
6T # lG/ ,8GX 7/ /u z/,ve, (9/�G ii
s /6
Please Complete Reverse Side
CD0492(Rev 4/93)
•
21 f✓ . GoIT
Lur 9 RIG
STRUCTURE Existing t SFR.... I Propose /AfS i.�/ ii I
Permit includes: ,� Building' ❑ Plumbing ❑ Mechanical0 Other (•
Type of Work: 1g Residential ❑ New TXRemodel 0 Number of Units 0 Deck
❑ Commercial 0 Addition 0 Garage 0 Shed - 0 Other
Enter 1st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft
Area Basement sq f _Decks sq ft Garage sq ft Proposed Total Area sq ft
Water Availability Sewer Availabilit On-Site Septic System Availability 0 k- Project Valuation $ L,SOJ
Zoning ^ l.G ... -r-fil., Lot Size 13/ 7 C/ 1 —I-
- xisting Bldg Valuation $ jr..7 3 0
Z-j
L•.k IER
,L
Na - Address
City State Zip
MECHANICAL CO 'ACTOR
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes 0 No
PLUMBING CON" RACTOR
............... .................................................... .
...................................................................... ..
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
PLUMBING FIXTURE COUNT
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Was -rs Drinking Fountains Other
Showers Electr' Water Heaters Sumps
Lavatories .shing Machine Drains 'Total Fixture Count
MECHANICAL UNIT COUNT MECHANICAL VALUATIO ONLY
Fuel Type (electric/other) Gas Dryer Air Handling < = 10,000 CFM 15-30 ins
Length of Gas Piping Range Air Handling > = 10,000 CFM 30-50 Tons
Furn <100K BTUs Gas Log Unit Heater 50+ Tons
Furn >100 BTU Fans Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers Above Ground
Cony Bu er Duct Work 0-3 Tons Underground
BBQ' 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 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
application.
Owner/Agent: far
— VZ,e—r--e--. Date: C//3/ ? /�