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Si e. 1- Tenant(if known) Lot 14_ Assessor's Tax# Building Owner's Name ntpt4t5 p f 44 ddress Ataksr-A 3 GoSO - I°A 1.' tivt. S .I Sk.42r6 City p caLvo-t._ 'State bi---ik-- Zip 9 Re0 I phone2-06 -6 41.-tf4-6)d Nature of Work -i--24.-4,.. -- I Ay A-A-e-g....7c- — WALL t r e,t1i)A45 rA,tztAi 3,a. - (,,,a2A,Lvt Name(F,M,L) ---e" (C.EIVAie,D C Cott-51-- Address I 3 --ozi q T-14 Av . Sr City P4.14 c.-/y State Mp 9 Aea. :.3 Conta41 f Nev,:i 3 Day Phone 6 354 Le* Other Phone Fax I .},,;:7„..„:„.,.. ... ( a-a) pA) fs L__*- S03 Company Name •.Address City e/ ; 100 ji2--- State Zip Person Phone Fax Contractor's#(card must beiprznteLI) 6 Expiration Date Verified 0 Yes 0 No •-1747-1 -Cr • .. . . Name Address City State Zip Contact Person Phone Fax LEGAL DESCRIPTION ti°7- i 4---- 1440 51- (AT 0.5 p vs 7) IC- -73-1 2- ,, Viol IT, 16 C t,,54. , r Please Complete Reverse Side • ,; r'ism j% ���•,A Existing Use A F I C ' Proposed Us- Permit includes: 1.Building 0 Plumbing 0 Mechanical 0 Other Type of Work: 0 Residential 0'New 1Z/Remodel 0 Number of Units_ 0 Deck Commercial 0 Addition ❑ GarageYla 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 Garage sq ft Proposed Total Area sq ft 0✓ Water AvaaillaOa'bility Sewer Availabilityy On-Site Septic System Availability 0 Project Valuation $ /4 6 Zoning C) I Lot Size 24 34-ill Existing Bldg Valuation $ 4 0 / fir. on /;!i/lJj ~:%fA %�� i Name Address City State I Zp '• g'./3•. lt'sr1 �l>P '. ss a,8''V.iiR r' Contractor Name Address • City State Zip Contact Phone Fax License$ Expiration Date Verified 0 Yes 0 No Contractor Name Address City State Zip Contact Phone Fax License$ Expiration Date Verified 0 Yes 0 ido • Water Closets Sinks Urinals Lawn Sprinklers Bathtubs Dish Washers Drinking Fountains Other Showers Electric Water Heaters Sumps ... ........:o.:................. ....................... `} Lavatories Washing Machine Drains `Fi�talFtue�Cflt�if `:�•'' : ..,.,. • r: MECHANICAL EVALUATION ONLY $ Fuel Type(electric/other) Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons • Length of Gas Piping ange Air Handling > at 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 DISCLAIMER:I certify under penalty of perjury that the information furnished by me is true and cared 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 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. 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