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Carr Or City,of Federal Way RECEIVED BY
v NITY NIVIIQPM ENT DEPARTMENT
APPLICATION FOR BUILDING PER
JUN 18 1993
PLEASE PRINT APPLICATION #: L oll',3-Qt`O/s
SITE LOCATION Address 3ud )5— -p L
Tenant (if known) I Lot# Assessor's Tax #
LoQfc -g .'3(-0•5-SOO-Oa I (Th
Building Owner Name Address
City epWLAX W� l State Lq �z �(�l
3 �
p q � ' Phone gL1u - Li`j
Nature of Work A �1 - c�-L R
APPLICANT
Name (F,M•L) Ll_ o J
1\12.e):5\d - -Thtk-A_A C
Address
City � � State WIC; Zip (--6 y f)9
Contact Person Day Phone Other Phone Fax
1 r-vCX_ Sv-e. 3 3`1 (--1 13-`rS 31 9
BUII;DING CONTRACTOR
Company Name
Address
City State Tip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Verified 0 Yes 0 No
•
ARCHTTEC'T..
Name
Address
City
Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
C00492'Rev 4/931
TRUCTURE i existing Use I Proposed Use
Permit includes: 0 Building 0 Plumbing Mechanical 0 Other
Type of Work: ' Residential 0 New 0 Remodel 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 ft Decks sq ft Garage sq ft Proposed Total Area sq ft
Water Availability 0 Sawer Availability 0 On-Site Septic System Availability 0 Project Valuation S_
Zoning Lot Size Existing Bldg Valuation S
LENDER. .
Name Address
City Sta I Zip I
t
MECHANICAL.CONTRACTOR
Contractor Name Address
(xr)ah (11 / N�C--f f-Ck. 1 (--;CI. S 31 a0 -5 3? 4
p�
City in L 1C�1 _ State L,k Zip CIL( U 9
Contact Phone Fax
License # .n7l S k` k)6 a—sC-\ Expiration Date-1-T-I Verified 0 Yes 0 No
PLUMBING CONTRACTOR ,
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
PLUMBING FIXTURE COUNT`.. .........::
Water Closets Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains dotal Fixture Count
MECHANICAL UNIT;COUNT
Fuel Type (electric/other) Gas Dryer ' Air Handling < = 10,000 CFM 15-30 Tons
t
Length of Gas Piping ac 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 I
Gas Hwt Hood Boilers Above Ground I
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 arises out f 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: ^Y^1 � Ji? Data. L _ 1 I