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BUILDING DIVISION •
OF G R V_D 33530 First Way South
• EIZAL Federal Way,WA 98003
ET 0 2 1998 (253)661-4000
Fax(253)661-4129
Ci CY OF Ft.L:" irilki vvA -
BUILDING DEPT,
APPLICATION FOR BUILDING PERMIT
PLEASE PRINT APPLICATION # ¢j\0 l?' ,-G(o G
:;3R•'::'t2i"rk"`�:::•.:���:.tw'.: SYa'.'f:r;,:.. ::�%:•:: :::,vrti#:`?>_:,:�:::'.::;i::;yG
`' }dad•.'.y' idat, %,.:;k::>,:>a::::�; . .�»w,riv::11 Address 3/O 69 C1" ' u/e7Y CGS/e,' If& cac/4„ /3,7Gr.J/if9 f/
ffT ant(if nown 0.'e-,7"nee•-•,• -s 7- Lot# , Assessor's Tax#
)'on k a•cn,,7Go. 08fr' S,"Gda7 Co.Oa.,,
Building Owner's Name Address �/
/1TG tr/rly/ CGK ri j J C. /Qo0/ ‘,..74 ,4 5',,,'_e 3200
_City :S�ajlre. /! State )VA Zip 7 /5ft [Phone
Nature ofWork f/✓/F�✓T SM fro�e'ltilel�7- - Jc i/S %. 1 t =.
Qee \.2cSN ,r `g...�s ,-\c
inginessioniiiiiimilimi
Name(F,M,L) Q y l7#1 / c-i7- / e"?�/i e
Address 3
213,4',�/ i C7O.° . �Ave J , /4, Z /
City /CG,�C.",,/ Way State , M Zip 780,Z3
Contact Person / Other Phone Fax
.5a.si c Day Phone c253)83.5= /nz
FEDERAL WAY BUSINESS LICENSE
1\� 1
Company Name
Address
City State Zip
Contact Person Phone Fax
Contractor's #(card must be presented) Expiration Date Verified 0 Yes 0 No
igiiNiiiiiiiiiiEgiMiiiMiNiMiNiMiiiigaiiiNiii
ARCHITECT> >> > ' >< < <><''?: M>' ?< '''
'Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION �J /
_5G C 417.9GL GG
. r
- Please Complete Reverse Side
i.x:Kvw•} .'.....{.......;nCii:;ii}r til..... ....f:•:{•v}i}:•i}}i•.}i., 4 ,
•w.r��..,:�::r.::a}^••::••,:�;:`tili `:'kS'' ff l .#3>' xistin Use Proposed Use
.•�..�.��.'`.?�.��''�.�...t�::.::::,v`'4:.ti;}`x,�c; c::::..:4..`v.:<•::::;::...,:::....:�i::{.., g C�c% �! P � 1
Permit includes: JK Building %Plumbing . Mechanical 0 Other
Type of Work: 0 Residential 0 New 4 Remodel i•4re itob' 0 Number of Units_ 0 Deck
'la Commercial 0 Addition 0 Garage 0 Shed 0 Other
Y_ Enter 1st Floor/ a sq ft 2nd Floor 0 sq ft 3rd Floor C2 sq ft Existing Floor Area /AD sq ft
Area Basement _0 sq ft Decks p sq ft Garage L sq ft Proposed Total Area /AVIV sq ft
Water Availabiji Sewer Availability$s On-Site Septic System� 5"
Availability 0 Project Valuation S 2. ,c2 2
Zoning C Cam. Lot Size 1 )O,(4L/-i Existing Bldg Valuation $ 31420
t ION"
r.�•;{�J[J•rrt r•:v.,i.,..f.ti}.};:: �F. ,v;: .;v,.} •.}•{Yi{
Name Address
K ion C ^ OtvK Cv /C 4,,,t�.C,e.?
City State I Zip
•i'c;}S::\a:tit;:;:.%`;:•.;:'::{?ehM.44.t}}y a 4 11
Contractor Name Address -
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
Contractor Name Address
City State Zip
Contact Phone Fax
License# Expiration Date Verified 0 Yes 0 No
Iiiiiiiiiiiiiiiiiiiiiiiikidialitill
Water Closets / Sinks , 4 Urinals o Lawn Sprinklers 0
,x, Bathtubs 0 Dish Washers 0 Drinking Fountains d Other
Showers G Electric Water Heaters / Sumps
Lavatories Washing Machine 0 Drains Tptal.Fixt.r.i ..._. .........................
COUNT MECHANICAL EVAL
ATION ONLY
$
Ge.,)
e a'".
i
Fuel Type (electric/other) 6-c7 s 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 0 Above Ground
Cony Burner Duct Work /,5c 0-3 Tons Underground
// D�etieK�iv.r
JillUies C9',ls Vet / 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 dull 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.
\ , wit
�( Owner/Agent: L � /�s� Date: 05' 6/ 7 O
///���BUILDIM.APP
atveEo 8/26/97 -- —
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