95-102230 •
O„C G City of Federal Way
,> -• A CATION FOR BUILDING PERMIT
SEP 01 1995
iii WE iUNDER1994UBC 9g~ 1O23
PLEASE PRINT CITY OF FEDERAL WAY E MS_0 7j 2
BSJILDING DEPT. Awe_
#:- p [J(,(J�( JG ?
I r; OCA ION .. Address 3025 C cRNie AwC_ S. Flit eI -c <'l) f O5 J
Tenant(if known) Lot# Assessor's Tax #
RA�PN) Si/ealzf S7- ie o 5R 33ellec, - O2S-d
Build g Owner Name Addresc -
City t I State Zip I Phon1(/o_ (08Y
Nature of Work l*"`'"' _2,44AkertPdi
APPLIGA T ..
Name (F,M,L)
!?,Pr1-Pf4 W i STviAl 12A Si-/e4-1241 G, Sr-v., P.�D
Address
3o2c5 aN' Ave S.
City getQ2d,E -i ',oft-NJ 4 State W N- Zip 9 D 00 3
Contact Person �� Day Phone 4p16, (ific Other Phone Fax
(Gl'J
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iEi�Nos CoN 'RACtOR
Company Name
NONe- UN.‘)/0 e2)
Address
City State Zip
Contact Person Phone Fax
Contractor's #(card must be presented) Expiration Date Verified 0 Yes 0 No
ARCIII EC'''
Name
OPLYtieR-
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
C00492(Rev 4/93)
,
i_ Use
STRUCTURE ting posed Use
Permit includes: Building jg Plumbing , Mechanical 0 Other i
Type of Work: j19 Residential 0 New ,ffi Remodel 0 Number of Units_ 0 Deck
0 Commercial Addition 0 Garage 0 Shed 0 Other
Enter 1st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft
Area Basement sq ft Decks sq ft Game, sq ft Proposed Total Area sq ft
Water Availability 07 Sewer Availability 0 n-Site Septic System Availability P Project Valuation $
Zoning RS 6, (5(2) I Lot Size 7,Lf 75'r. Existing Bldg Valuation S )
C>/4Sc 5504
LENDER .
Name Address
City State I Zip
MECHANICAL CONTRACTOR
Contractor Name Address
owns .R-
City State Zip
Contact Phone Fax
License if Expiration Date Verified 0 Yes 0 No
PLUMBING CONTRACTOR
Contractor Name Address
pwNeR
City State Zip
Contact Phone Fax
License if Expiration Date Verified 0 Yes 0 No
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PLUMBING FIXTURE COUNT
...................................................................................:.......
Water Closets ' Sinks Ia. $ Urinals 10 Lawn Sprinklers
Bathtubs 40Dish Washers Drinking Fountains 9 Other
Showers 1 , Electric Water Heaters 0 Sumps 0
Lavatories 1 Washing Machine ( Drains 0 Total:fixture Ciitint .,,;4r(2 :
MECHANICAL;UNITi.:COUI 'I'
Fuel Type (electric/other) &AS Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons
Length of Gas Piping "1.. 9o/ Range ' Air Handling > = 10,000 CFM 30-50 Tons
Furn <100K BTUs Gas Logr1,RLptp,e4. 1 Unit Heater 50+ Tons
Furn >100 BTUs Fans Z. Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers Above Ground
Cony Burner Duct Work 0-3 Tons Underground
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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 reli ce of the City,including its officers and employees,upon the accuracy of the information supplied to the City as a part of this
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1/ ___Ai , Date: /(/ /--9 9