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96-100417
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M. }- N r{ A O r C WA v a It A 0. = CAc» a x u N WACn CC Ul Z C7 cn Z CM N t..1 . cc H (� � � AO � JCVIa o• a tl Ja- W V ¢ > In II oQ o ¢ OaaQ ¢ ¢ N LW W •--. II - V CD ..0, H- •• • II a.. V CO CO CC CO N I.! v = V COtl_ Q Z 0- C¢c Iw `�� N a CI. 1••I o ar,or G City of Federal Way APPLICATION FOR BUILDING PERMIT IRECE \/ED PLEASE PRINT FEB 13 1996 APPLICATION #: L�✓ �(� SITE LOCATION .. pddfess te2� 2c UVVY _ti ,rtlWRY Tenant(if known) BU Di DE T• Lot # ssessor's Tax # OLD �E✓� r- �y io su,(Iding Owner Name ` Address Name kti City ©(`� �� State ��jr Zip Phone LIo) -2�S--lo6Z. -7 Nature of Work a.N -C'ta i— �� c .� ��, � /O 1 'j-o 1,3c.._.- �t� r„c'eJ ; :i<uS, cc i. i r i Q �& Z'c. J) APPLICANT Name(F,M,L) Address City State Zip Contact Person Day Phone Other Phone Fax BUILDING CONTRACTOR<I Company Name ( _ Address ,�/ k:km ]\ City n ca.e. State L . Zip 2 7 7 Contactorsonip `E ,,/q�.,gram,�. ;r Fax cam— G,, \ c l t "- t101-igL4u1 `ic7 �32f'SNU Contractor's #(card must be presented) t'21ightki', ( 'f Expiration Date Verified 0 Yes 0 No '•N Q r c..e S...S O'erk(OQ( VAC'f tip J ARCHITECT Name Address City State Zip Contact Person Phone Fax .GAL DESCRIPTION Please Complete Reverse Side C00492(Rev 4/93) STRUCTURE t sting Use oposed Use Z C �— C� 1G�� . c'� Ga Permit includes: 0 Building 0 Plumbing 0 Mechanical 0 Other ' Type of Work: 0 Residential 0 New Af Remodel 0 Number of Units_ 0 Deck Commercial 0 Addition 0 Garage 0 Shed 0 Other Enter 1st Floor-2?7 G sq ft 2nd Floor` sq ft 3rd Floor sq ft Existing Floor Area '777:. sq ft Area Basement sq ft Decks — sq ft Garage sq ft Proposed Total Area -,7 7 0 sq ft Water Availability "Sewer Availabilit y �On-Site Septic System Availability 0 Ir. Project Valuation �;A C...)nip Zoning 0—C_. Lot Size Existing Bldg Valuation S U4 elk.) �}I4°Do LENDER Name Address 4 tJ—Q--- City State Zip MECHANICAL CONTRACTOR Contractor Name Address City State Zip Contact Phone Fax License# Expiration Date Verified 0 Yes 0 No PLUMBING CONTRACTOR I' Contractor Name Address City State Zip Contact Phone Fax License # Expiration Date Verified 0 Yes 0 No PLUMBING FIXTURE COUNT • Water Closets Sinks Urinals Lawn Sprinklers -r Bathtubs Dish Washers Drinking Fountains Other Showers Electric Water Heaters Sumps Lavatories Washing Machine Drains Total Fixture Count MECHANICAL UNIT COUNT 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 l am authorized by the owner of the above premises to pe rm 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 in r d: investigation nd d fense of such claim),which may be made by any person,including the undersigned,and filed against the City of Federal Way, but only where suc cif arises out of th relia e of the City,including its officers and employees,upon the accuracy of the information supplied to the City as a part of this application. % caner/Agent: �� f.1�' t+C,41 Date: ( / v 38/-R2-ioN fro _. it.d 1 Sid . 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