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RECEIVED
APR 121 ' City of Federal Way
��� PLICATION FOR BUILDING PERMIT
or
CITY OF FEDERAL WAY
• BUILDING DEPT. _
(� ��
PLEASE PRINT APPLICATION#:
lotitudottotintioninundAddress
Tenant(if known) !% ,NA- COGN, 21•1 , Lot Assessor's Tax#
Building Owner Name Address
ca.Gc1l�E �y¢ G. 1z0 Ave. al•E.+147
�EG-I-retie -
City !State �.. Zip Qt3 pOJr I Phone '�S- ''SQ�
Nature of Work 'atAtt Z7tt.16 ?j "1'A4T-0
Name(F,M,L)
l\1(0-c �l+l46 + A SDGtPireS'
Address 3312
n smtm. v r
City -�YAW 1f�'C'_ State WA-. ZIP -Q 18104
Cont ct Perso; � Day Phone /22 �� 1 Other Phone Fax 6e2.
Company Name
Address '40
to . U L6,J1-k 13wv. WE. 'oY t
City 1442444.44417 State Zip Td'D33
Contact Person
PhoneQ2S_o oo Fax SIN- 1106
Contractor's I(card must be presented) ``C. ciration Date Verified 0 Yes 0 No
.:. E r ` `aiMi '::>::»::>::>::<:»::::>::»:<::<:>:::>::>:::>:>:i:<::
'Name
Zvi( t2- 5tHµ'4 I Act :.
Address <<33�.,i�on�,., �
City (71.�IC1"LIs� State Wit,. Zip fen+
Contact Person 5TrAia 1�^I Phone �`I Fax�2
`wC's'frvw.�w 9
LEGAL DESCRIPTION
1--or-2- OP 64 1 Couwy 5tf1' ftiocr kLLLM iZ 18202.7
AGc-oWZD lw -rt' Sit D PLAT eorWED wom ( Lt c
CoUlc t-t/ j NUMBS 8403 t4 n?5 2 . StT t t7 14 -(t}6
Grt-� dp- mazki. \i! Cout_tm - t 4Nl , rTA— D(1' 1�J 1�1G-t>�tJ
Please Complete Reverse Side \
C00492(Rev 4/93:
1
1 \
'
Existin Use PPro osed Usablootowilifoommind
Permit includes: firBuilding 0 Plumbing 0 Mechanical gill Other
Type of Work: 0 Residential IVNew 0 Remodel 0 Number of Units_ 0 Deck
1W Commercial 0 Addition 0 Garage 0 Shed 0 Other
Enter 1st Floor 652.Osq 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
Water AvailabilitySewer Availability On-Site Septic System Availability 0 > Pojec4Vlaon $$.: ''..-.. }''""
Zoning C C. !Lot Size �7�$83 SiF. ..: a;::<n9`:.8i9>::: o:> D iorx''.lt ><>».>;<::>::>:>:>:>:.>:::::»:::.;:*::::
...........................................................................................
............................................................................................
...........................................................................................
............................................................................................
...........................................................m:,:,........................
........................................................... ..............................
.........................................................................................
Name 6�/l� Address
City State I Zip
Contractor Name Address
lb 1V- VT542.M0\10.0
City State Zip
Contact Phone Fax
License I Expiration Date Verified 0 Yes 0 No
...........................................................................................
...........................................................................................
...........................................................................................
PLUMBING="CONT'RAf TOR _<::: ::;;;
........................................................................................:..
...........................................................................................
...........................................................................................
Contractor Name i D 'e P 9 M tLEv Address
City fig State Zip
Contact Phone Fax
License I Expiration Date Verified 0 Yes 0 No
...........................................................................................
. ................................................................................
.......................................................................................
PLUMBING; U �.cool <«< <«
Water Closets 1p .................. Sinks Arr i Z Urinals 3 Lawn Sprinklers ....
Bathtubs -- Dish Washers I Drinking Fountains ...47' Other _ _
Showers --- Electric Water Heaters I Sumps
................................................................
a 'Lavatories W shin Machine Drains [l a : ""
C> ICALUSi ::COUP:>'< »»[>>
......,:.:::........................................................................i*i:.: ..
...........................................................................................
............................................................................................
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 ust.....aunt:::;:::`;:; ; ? < >
..............:.::.....::.........................................
.................................................................
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 who .- arises out of the reliance of a City,including its officers and employees,upon the accuracy of the information supplied to the City as a part of this
application. A Q
Owner/Agent: ,/t{ JA. A i_i .. . I Date: 4- to-R�'
r -
i
OV4tikariAll-
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