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•
R ECL- !ED City of Federal Way
JULARA$ WATION FOR BUILDING PERMIT
CITY OF FEDERAL WAY
BUILDING DEPT. —I.S l,— 219
PLEASE PRINT APPLICATION#: t� — 60
ottoott :::. :.:.;:.;:<.;;:.:: Address 3/.
Tenant(if known)/1 �A r C/�tt XL, A` I Lot# Assessor's Tax#
Building Owner Name //WI Address
City r. to. State MA ►I elk.. I Phone
TA of Work s F�a S, �n kr.f.eke ov f C( )
. atop /J/'1CQ
Name(F,M,L)
(_.GYM-fiat 116Y
Address
City
State Zip
Contact Person Day Phone Other Phone Fax
1B U1141.0 WOOSl'RACTOR; 1
.:... .......
Company Name
'/O //^ �/�
Address f'L C./I f'e 1 �1�f /n,i-r Co •
/ r W
City / �c�t.,C_ G state
,,()I�t Zip `I/E S
Contact Person Torn a �
Pho cif._
/._ _ (1
46,2
Contractor's S(card must be presented) Expiration Date Verified G Yes 0 No
Free e T ik ZOO J/)
Name
Address
City State Zip
Contact Person % Phone Fax
LEGAL DESCRIPTION
•
,.
P/ease Complete Reverse Side
C00492(Rev 4/931
S'it.UCT 'i ` E)' I Use eQSla.C-Cf •kI I sad Use seAyyt.e
Permit includes: 0 Building 0 Plumbing Mechanical 0 Other
Type of Work: Residential 0 New 0 Remodel 0 Number of Units 0 Deck
Commercial 0 Addition 0 Garage 0 Shed 0 Other
Enter let 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
Water
AvailabilitySe
wer Availability
� OmSite Septic
c
System Availability
.i< >::F�.:fd4t.::::::::4.4ian. *:: 2/69• ..........
tiiigligi
Zoning
Lot Size
LE ;:;>::
Name Address
_
City State 1 Tap
:ice'::::::::>:::: ,,,::>: >: ::::::•,•:::>>:>:::<.::, <>
Contractor Name •Ad• -as
City State Zip
Contact Phone Fax
License# Expiration Date Verified 0 Yes 0 No
PI '
Contractor Name . Address
City State Tap
Contact Phone Fax
License# Expiration Date Verified 0 Yes 0 No
/
•
• Water Closets S' ks Urinals Lawn Sprinklers
Bathtubs 'sh Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories WashingMachine '"<<_<:
Drains ��18��': :>: :< iltl['.» ': r> >^: •>:
•
V �� � . AL?.I,t T`CO l. ;::
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
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 wort 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 in ,tigatlon and defense of such claim),which.may be made by any per,including the undersigned,and filed against the City of Federal Way.
but only where such 7 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. N
Owner/Agent: ,r• .1 Date: /c h 1/,1