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I- -1 Il. 1-- cc = < Um. ci. ce v 0 CL 0 a .. j Cc F- al bz t y CO Is) LU US m i�0., F- n > ES piCI• w HI x. 0- 00 Q a VI 0 3 o v 1 a w 0 t X Z * rhLU * * _ .n 3 4 - CC t - lN1 0 V O ! 0y'rN^ 11 al z g Nil Ite. 0 --� zb I cz 0 w Q A U G City of Federal Way - APPLICATION FOR BUILDING PERMIT PLEASE PRINT APPLICATION #: 13 L ) 52 -U) 8> SITE T OCATION Address 1( y�y 7 e/ / $ Tenant(if known) Lot# Assessor's Tax # ��/7/) /7/' Building Owner Name Address S9r City State Zp 9 Phone C Nature of Work APPLICANT Name(F,M,L) %%O /-i7e c/SGi��J� Address zz / • JOB S ,? / ll/GS J , City C�1`iF iZ OG (.�// j I.11s1;1. State Zip Contactn Day Phone Other Phone Fax (.42 l/�,��,� Q'-� 6 - 3 Bumty CginaCTOR Company Name Address City State Zip Contact Person Phone Fax Contractor's #(card must be presented) Expiration Date Verified 0 Yes 0 No ARCHITECT., . ...... Nairte Address City State Zip Contact Person Phone Fax LEGAL DESCRIPTION Please Complete Reverse Side CD0492(Rev 4/93) RUCT(JRh xisting Use L. Proposed Use permit includes: Building 0 Plumbing 0 Mechanical 0 Other of Work: 0 Residential d New 0 Remodel 0 Number of Units_ Deck 0 Commercial 0 Addition 0 Garage ❑ Shed 0 Other nter 1st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft Area Basement sq ftDecks )PZ—sq ft Garage sq ft Proposed Total Area sq ft Water Availability 0 Sewer Availability On-Site Septic System Availability 0 Project;Valuation $ Zoning # J 7 , Lot Size Existing Bldg!Valuation S . : l ,,ENDER _ Name Address _ City State Zip MEN . :CONTRACTOR Contractor Name Address City State Zip Contact Phone Fax License # Expiration Date Verified 0 Yes 0 No PLU CONTRACTOR Co tractor Name Address City State Zip Contact Phone Fax License # Expiration Date Verified 0 Yes 0 No PLUAZB FXTURE=COUNT WatecClosets Sinks Urinals Lawn Sprinklers Bathtubs Dish Washers Drinking Fountains Other Showers Electric Water Heaters Sumps Lavatories Washing Machine Drains Total iFixiure Count • AIECHANreADAINIZ COUNT 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 Fuel Tanks Gas Hwt Hood Boilers Above Ground Cony Burner Duct Work 0-3 Tons Underground BBQ'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 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 oo} he City, including its.9fficers and employees,upon the accuracy of the inform ion supplied to the City as a part of this ;:/:'nt: Tom . , Date: ' `-. 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