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BUILDING DIVISION
CR1Or a 33530 First Way South
EIS Federal Way,WA 98003
(253)661-4000
RECEIVED Fax(253)661-4129
AUG ® 61999PPLICATION FOR BUILDING PERMIT
Crry OF FEDERAL WAY Q0.�� (�n/�
PLEASE PR/N7BVILDIN(�DEPT. APPLICATION# 'JU,�"1"I—�56
• e 10c1f`11M Site address + `''I
Tenan tc-hu- Alit"' / ,�' ', ,n( / Lot# Assessor's Tax#
Buildi Owners A I/ Gc..v l .(04.)
',} ress
City 1J State w A' Zip 960 'Phone •(g i(,p
Description of Work %1., ,iJ .np }.,Ved4 j t 1 MTh
::.{:'+J.Q:i f} � '..::::t.,..,.,,,,„0,.......,..r. !f '''if}il•.::.ri::`Gv�l.�..` ';
tintagemfrA
Name(F,M,L)
Address p D a
City Q(+�,Q t 1 State
LOA Zip cf2a.03ow;
Contatrirgon I Other Phone Fax
tigt,.. 1138,,,t
•u'lQ1
:.::yr� �:ro:2:::r•:,. :•. :fry 2t:'•:r.::f:::<::
BU( CO . .O....;r'r•,''s I Federal Way Business License #
Company Name
c".1(4-6
Address
... City State Zip
Contact Person Phone Fax
Contractor's #(card must be presented) Expiration Date Verified 0 Yes 0 No
����yy....CC��ii!.,y+�++,, :2'r,•::i{fr:i:f :i r..r.;;:i::r::•?r.,•::•:•;::
�:k+1`Ti'i.:l'::':'`' .:�':7i:`::.f.:•iffi.'.,.;.'t.;•}:r;'.•/.•::;«f:>:A;.•/.%:{j
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
• Please Complete Reverse Side
iiiiikiriaMININISEEME Existing Use Proposed Use
Permit includes: 0 Buildin 0 Plumbin ❑ Other —
7?"ift Type of Work: 0 Residential 0 New 0 0 #of bedrooms 3 f3eekr
0 Commercial 0 Addition 0 Re air 0 Gara e 0 Shed
Enter 1st Floor sq ft Floor sq
Floor Existing Floor Area __ sq ft
' Area Basement _ _ _ Proposed Total Area sq ft
WaterrAAva4a161fl Sewer Availabili 0 On-Site Septic System Availability 0 Project Valuation $
lelfing I Lot Size Existing Bldg Valuation $
, : : . .. iii:ING •
�« ' wggaM:£ r <M; : For new residential only- Proposed selling cost• $
Na Address
City State I Zip
il /ya icy■ y}. iiitiii:jl::;
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiratio. 'ate Verified 0 Yes 0 No
...................i!:: ........................ i:::i...................................
i::i::i::i::iiii::isc•:i::i::i::i::i::i::i::i::i::ii:;<:;•%'<;:
PthAfiaiNGZONTRACTORMEREM
Contractor Name Address
City State Zip .
Contact Phone Fax t
License # Expiration Date Verified 0 Yes 0 No
............mi:i...................................................................-....
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washe • Drinking Fou ains Other
Showers Electric - ater Heaters Sumps
Lavatories Was r'ng Machine Drains 1.'itaIF6(t4tt.t...4kTIt........................
IIV,
::i::'i ix:ix:
�i1� 1}�1 #�lCE'��'i <`.;:,�::,:::::.,;.••. MECHANICAL EVALUA 4 ON ONLY $
Fuel Type(gas/electric/other) Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons
Length of Gas Piping Range Air Handling > = 10,000 CFM 3 0 Tons
Furn <1 OOK BTUs Gas Log Unit Heater 50+ ns
Furn >100 BTUs Fans Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers Above Grou
Cony Burner Duct Work 0-3 Tons Underground
BBQ's Wood Stoves 3-15 Tons Ta£el>aJrnt.. ..
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.
Owner/Agent: % I(4L1
'7ida/1 1,r iz_� Date:
ButDi,C.AM •7
NEv6Eo 6118199
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