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City of Federal Way T ,
�� ��' ICATION FOR BUILDING PERMIT j
MAY 21993 FILE
PATY OF F D MML WA'.
PLEASE PRINT o n T APPLICATION #: (3C A)9 3 - O J /7
SITE LOCATION Address 2 j S. s'
Tenant (if known) Lot #9 rj�C e G✓P s�' Assessor's Tax #� 10 C _
1M 7
Building Ow9 er Name Address
jo A ) Lou v2 2/5' S. (2. E
CityT7-Po(B/LO✓t State ? n _ zp I700S Phone q y/— 5 '
Nature of Wor �,,�i )� /t `5i—
APPLICANT
Name (F,M,L)-r—
Je /nl L_ Lazt. ise' //
Address
9/5s. z4"
City /t;m R A ) It)Ai L( State lit/�, Zip J( 0 o
Contact Person J Day Phone O er Phone Fax
a- I v ) - 5�i
BUILDING CONTRACTOR
Company Name
Address
City State Zip
Contact Person D OAU f o ("e Pjpne� � ' Fax
Contractor's #(card must be presented) Exiration Date Verified 0 Yes 0 No
ARCHITECT
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
. /o (11 -(7zZt//eS J Vo//i U cf p/A7-s
f p✓ 7Xieo�� � /G
Please Complete Reverse Side
CD0492(Rev 4)93)
•i\ STRUCTURE - ' xisting Use Proposed Use 6/71i"p�=/rLJ k7-00i`--/
Permit includes: ,Building ❑.-Mtn ❑ A4o^�a ic,a 0 Other
/
Type of Work: XResidential 0 New Remodel 0 Number of Units_ 0 Deck
ii D =7, ❑ Commercial 0 Addition 0 Garage 0 Shed 0 Other
i
Enter 1.,r leror j,1 Yet;'q ft 2nd Floor sq ft 3rd Rosa sq ft Existing Floor Area sq ft
Area Basement sq ft Deck sq ft -,Garage sq ft Proposed 3aLAre,@ _ sq ft
T
Water Availability Sewer Availability On-Site Septic System Availability 0 (Project Valuatiot , $ 0 p O ;
Zoning Lot Size Existing Bl g Valuatior $?too O es
LENDER N/A_ .
Name Address
City State Zip
MECHANICAL CONTRACTOR (V/%!
Contractor Name _ Address
City State Zip
Contact Phone Fax
License # - Expiration Date Verified 0 Yes 0 No
PLURZBING CONTRACTOR:: All/-
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
PLUMBING FIXTURE COUNT A VA-
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total Fixture;Count
TIECHANICAL UNIT COUNT- /tl//?_
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 of the City, including its officers and employees, upon the accuracy of the information supplied to the City as a part of this
application. .
_
X.Owner/Agent: <:f� r l' I :/) ..�f ._/:- _J Date: t.0— �` ( 3