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p,,,r City of Federal Way
RECEIVE APPLICATION FOR BUILDING PERMIT
PLEASE PRINT DEC 1993 APPLICATION#:
:SITE O AtiON $60000 9.:Ati': Address 09 it? 23 rc PQ-. S
Tenant (if known) Lot # I Assessor's Tax rI
( ' 'r t{12292-00(0 -CI
Building Owner Name �, Address
o+t& 1. SLisccr, A, Geel s :261 i'f 6 ' 3 re PP. S.
City T ck'c- . t � State Li A Tip ci v 3 Phone ci y l- j4
Nature of Work z 7e4st Q�wl.o.
I
APPL. CANT ...
.. ........
Name (F,M,L)
TYno—tn s. Gee(5
Address
City cede-r�Sc W� �1�"it 12(1z(CI 3 state i4A Zip 1SCO3
Contact Person Day Phone Other Phone Fax
Cl05
l CIO, 9q(-a3cf
turwir.siG,Tosali4eT.04gmaimmin
Company Name n '
Address
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
ARCHITECT;
Name t •
Address
City State Zip
Contact Person Phone Fax
.EGAL DESCRIPTION
1_6 - I I Lau re(weal Avi-s1ilA - Ctcccrci +z, la'F lrzo
re col-d.,c krllute $S o--c p1.4-s , s`l lyt V,v t), Ce4, t We-sLk l-rfiA•
•
Please Complete Reverse Side
CD0492 Rev 4/931
1 I(r(L�IL�� 4t �/3/�
STRUCTURE Existing Use b4u,, 2 Proposed use
Permit includes: c Building N( Plumbing Pi-Mechanical 0 Other
Type of Work: %Residential 0 New Remodel 0 Number of Units 0 beck
0 Commercial 0 Addition 0 Garage 0 Shed 0 Other
Enter 1st Floor (t O sq ft(Counks 2nd Floor //30 sq ft 3rd Floor sq ft Existing Floor Area 2,/ 4O sq ft
Area Basement sq ft S"� ) Docks /c.J sq ft Garage 'a"-' sq ft Proposed Total Area 2(e1 u[`� �1sq ft
_":
Water Availability - Sewer Availability On-Site Septic System Availability 0 : e�`, Pria/ect ValuatJon : S f ,yr'��}�'. .-+� ::
Zoning i.de„c 1-tc.._ I Lot Size cl r c..x,o SG. ,ree f' Existing;Bldg o.00on $ .4j::lita
/ 3�t:} Wes l- E,,,,s S}rce t-
LENDER I' L P.U. 3 : 100531
Name Address
I tee f 1-u.vtd1vt. - fJ€99 f4A-4,, +0-
,z/,./c.-)
City l ?r-,'F . . 10,715 , foCevtce. State —t & SC Zip s-ci- -OsIce.
re, n/i z/, }
.MECHANICAL CONTRACTOR �Z so j uS3?
Contractor Name Address
Nz,>t-A--
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
PLUMBING CONTRACTOR
Contractor Name Address
New- .
City State Zip
Contact Phone
Fax
License # Expiration Date Verified 0 Yes 0 No
PLUMBING<F'IXTURE COUNT':::
Water Close Sinks / Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountain Other
Showers / V Electric Water Heaters Sumps Lavatories I Washing Machine Drains $U 1/� t Tota(Fjxtiiie Coulit
MECHANICAL UNIT COUNT
Fuel Type (electric/other) &-a5 Gas Drye' I Air Handling < = 10,000 CFM 15-30 Tons
Length of Gas Pip (,p" Range Air Handlingc\> = 10,000 CFM 30-50 Tons
Furn <100K BTUs Gas Log Unit Heater 50+ '_n3
-
Furn >100 BTUs Fans Miscellaneous Fuel Tanks
Gas Hwt � ,}2 Hood ` Boilers Above Grour:;
Cony Burner Duct Work -aa-e"1, /Z//r . 0-3 Tons Underground
BBQ's Wood Stoves 3-15 Tons Total Unitoun Ct
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 a 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 r fence 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: �—� ( (72-
G Date: 2 /q3
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