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BUILDING DIVIS
arYer G rGENE° 33530 First Way g
Federal Way,WA 980
�� 1q (206)661-4
Fax(206)661-4129
Cs6 4.e ,'r F Ll EliAp wAY
t3U1t.DING DE.
APPLICATION FOR BUILDING PERMIT
PLEASE PRINT APPLICATION# 1 S C I7 O0
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.......................................:....................<>�;z:.} :•:;n.{,:,}��,,. :• Address � GtY�I✓�.� �Q� (rt � , _
Tenant(if known)--pr �O KI
Lot# Assessor's Tax#
Building Owner's Name (1 avle2Cvi (a/y.)1_) Address r..„ c.t ,, )
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City I tate I r ohe
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Nature of Work Dee)i/.�Vl d' 11.45 fei )14,1 1 i o n Q 'C" foft. cv vi L 1 f✓? �p Vn 1-7
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City G.,,,_w et State VA zip "W72.
Contact Pe(soin' Day Phone �L(( \ (51(6/..j Other Phon, a Fax
iiiiiiiiiinditifitaitittlIMER
Company Name ott 1,c,\ (3„ l , tiuc.6.41,11,,,, ri..4.- t,t_l_t. ,_____,
Address L� (�-
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City
State Zip
Contact Person Phone Fax
Contractor's #(card must be presented) Expiration Date Verified ❑ Yes 0 No
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Name
Address
City
State_ Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
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r�.:' };. `\ J k ;:•: "{ 9 r. .o osed Use
i . f'c . 3fi`°`:�i:h • tin Use p
Permit includes: 0 Building 0 Plumbing 0 Mechanical 14 Other
Type of Work: X Residential 'A New 0 Remodel 0 Number of Units_ 0 Deck
0 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 ft Decks sq ft Garage sq ft Proposed Total Area sq ft
�D�•�,— 0^ '-i
�
Water Availability 0 Sewer Availabili 0 On-Site Septic System Availability 0 Project Valuation S S�J
Zoning I Lot Size Existing Bldg Valuation $
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Name Address
City State ,Zip
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Contractor Name Address
City State Zip
Contact Phone Fax
License# Expiration Date Verified 0 Yes 0 No
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Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
:? :;:.nvi:iit i>}iiia:•:::'r:+mi:x:t{tik i ii::}: ::iimi:iR::i{?Kii:: :::•ki ::::ii:r ig:
ittUranitMEMPIRECOON
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washin
g Machine Drain
s
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i s ''<C ii :: :'::::?: MECHANICAL EVALUATION ONLY $
Fuel Type(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/f KC(,(5Y Fuel Tanks
Gas Hwt Hood- Boilers l Above Ground
Cony Burner Duct Work 0-3 Tons Underground
BBQ's Wood Stoves -
3 15 Tons
DISCLAIMER:I certify under penalty of.- 'ury 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 < 'ch 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 investi t. '..an,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 I.
.: .fthe city,including its officers and employees,upon the accuracy of the information supplied to the city as a part of this application.
Owner/Agent: ` Date: (/) I('- ' 1)7
i
Buadra.APP
REVISED 12/11/96 1