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BUILDING DIVISION
"ff°� a 33530 First Way South
FM'
2� Federal Way,WA 98003
ED (206)661-4000
-_ ?.1:27 .0 Fax(206)661 aim---
9. 161991
APPLICATION FOR BUILDING PERMIT"
AY
OF 1-' o
PLEASE PRINT \frijZ\\S k rs a APPLICATION# G ►J _0 1
i/;s 8:, -;a:`��* �� /:� ,-s;'l,� fs, Address C=(J evi .
Tenant(if known) Lot# Assessor's Tax#
Buildin Owner's Name Address
t�4srEAXI co.acca.C._%n.L r_vit..Lmot•AN• . A.%115 PAc,�'ic Ntc, . s• 5-\C)A
City cit_0Q.t LAJt I tate t,J A Zip �'t A8a 3 I .gar Phone q j(-66007
Nature of Work ("Qtb Q�PU4Cs...&4.'t"
Name(F,M,L)
Address
City State Zip
Contact Person Day Phone Other Phone Fax
Company Name \ otk
r1/46.ik
V,-..,
6:00 riNG 1tt)C•
a
Address P.ID ./ c1-3`s
City d•,E./`7r-t'Q b State Li A Zip 9 '(6 y
Contact Person Phone fax
�A"`'t.. ma2_ ud .. C201 Y39-999I (:11X)y39-9995
Contractor's#(card must be presented) ".....cz ytc 153 M 9 Expiration Date Verified 0 Yes 0 No
WI.t/qe
,tt
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
; M:. !->r. f z• : Existing Use I Proposed Use
Permit includes: CI Building 0 Plumbing O Mechanical 0 Other
Type of Work: 0 Residential 0 New 0 Remodel 0 Number of Units_ 0 Deck
510Commarcial CI Addition 0 Garage 0 Shed 0 Other
Enter 1st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Roor Area sq ft
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area sq ft
Water Availability CI Sewer Availability0 On-Site Septic System Availability 0 Project Valuation 8 I`SI335-
Zoning I Lot Size Existing Bldg Valuation 8
Name Address
City State I Tap
r'F 17<r • 3a '3 e1,f''fr �J i'
Contractor Name Address
City State Zip
Contact Phone Fax
License I Expiration Date Verified 0 Yes 0 No
Contractor Name Address
City State Zip
•
Contact Phone Fax
License it Expiration Date Verified 0 Yes 0 No
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
p'• 1'-Lavatories Washing Machine Drains :"gi ."''
r grY : re d% ;f % fr ii MECHANICAL EVALUATION ONLY $
Fuel Type(electric/other) Gas Dryer Air Handling < - 10,000 CFM 15-30 Tons
Length of Gas Piping Range Air Handling > g 10,000 CFM 30-50 Tons
Fum <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 :(" I>;l'#1 ?'Iw,'a :.::::::::.;:;>:.;;::;.:::.::.
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 • of the city,including its officers and employees,upon the accuracy of the information supplied to the city as a part ofthis application.
Owner/Agent: (- A G9 L4 Date: '"f' 14' 9 7-
euaawo.M
RIEVISE0 anima
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