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,.
anrCW33530 First Way South
Federal Way, WA 98003
,f— sr-,(253) 661-4000
Fax (253) 661-4129
S E P
APPLICATI(,?.,N�r-F-ORti,BUILDING PERMIT
_DING DEPT,
"LEASEPRINT APPLICATION
gg
addr
�
s v ,. Site tsss
r
Tenant name Lot # Assessor's Tax #
Building Owner's Name P Address I 1
citye �- U 0- State zip `' ^ T 4 0 C) Phone
Description of Work nJ - e ^s� e1 L/`
1
Name, (F, ,L)
Address fr r
Cit Ea State Zi
Cram ct Person Day Phone Otrser one Fax
Federal Way Business License
Company Name
Address t t
( r
Cit. L c3 State Zi
Contact Person (Phone Fax
Contractor's # (card must be presented) ( ' Expi atio Dat ' Verified heyes ❑ No
Name
Address
City State zip
Contact Person Phone Fax
'--I"Eu
.; isting Use
Proposed Use - c e, 12 :°` ''
1
Permit includes.-
5uildin
❑ Plumbing
ltanical
❑ Other
Type of Work: ❑ Residential
❑ New
❑ Remodel
❑ # of bedrooms
❑ Deck
❑ Commercial
❑ Addition
❑ Re air
❑ Gara e
❑ Shed
Enter 1 at Floor sq ft
2nd Floor
sq ft 3rd Floor sq ft
Existing Floor Area
Eiroo sq ft
Area Basement so ft
Decks
sq ft Gara e sq ft
Pro used Total Area
sq ft
Water Availabilit ❑ Sewer Availabilit
❑ On -Site Se tic System Availability ❑
Proiect Valuation
$
Zonin
Lot Size
Existing Bldg Valuation
kk < r ?
w{ 1, � .�
For new residential ar1/ - Pro ossd llial cost: 5
Contractor Name
Address
cityState
Zip
Contzct
Phone Fax
License #
Expiration Date Verified ❑ Yes ❑ No
p,
Water Closets
Sinks
Urinals
Lawn S rinklers
Bathtubs
'Drinkinu Fountains
Other
Showers
actric Hat
Sumps
Lavatories
Washin Machine
Drains
7te1"facttstat ,
MECHANICAL EVALUATION ONLY $
Fuel T e (as/electric/other)
Gas Dryer
Air Handlin < = 10,000 CFM 15-30 Tons
Len th of Gas Pi in
Ran a
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
Conv Burner
Duct Work
0-3 Tons Underground
BBEs
Wood Stoves,,
3-15 To `l,it Uhft,rLubt
/\
DISCLAIMER: I lyy'under penalty of
at the information famished 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 t perfonn the work forwin
p it application is made. I further agree to save harmless the City of Federal Way as to any claim (including costs, expenses, and
attomeys' fees incu in' vesCiation and de fe
e uch claim), which may be made by any person, including the undersigned, and filed against the City of Federal Way, but only
where such claim aril o t fits oliame of the ity, i ludin it Es c " and employees, upon
the accuracy of the information supplied
S
7777-
Owner/Agent:
Date:
BUILD- AP
REED 5/18199