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P.1••4 O
BUILDING DIVISION
CO"' a Re° ` 33530 First Way South
O EEf L. Federal Way,WA 98003
ifiY 2 rat - `„ gpo-
Fax(253)661-4129
APPLICATION FOR BUILDING PERMIT
PLEASE PRINT APPLICATION# Zip CI 9 dt +CJ
{ , N W ONEP ff "}fr AddresQ1VS ,::24# .4(h✓E , iti
Tenant(if known) Lot I Assessor's T x I
43G376_n,SD
Building Owner's Name, q/A/15
Address /1Q „L._/,—
City �� i c.i State �/J f C '
9i9A4té� i1/ zp 0�3I Phone 7�Nature of Work
..r.. . ,..r .. f::f • ,,::
r
Name(F,M,L) (:)04e iakr 4*ted4,2,,,,,,,,s ✓/V, ,
Address/7/
7 t)Q At' 4/ 4t �/�'4
City Pk)- 4'I& � State Zip �ifr/ 3
Contact Pgtaarff Day Phone Mom- Ot a Phon Fa !.
C-ionta �/e S ..242 �sQ >f//O Z3- ���i s, = 53 gx_8 .
:f{r«}:th f. . r ,,: f BUSINESS LICENSE #
�j ��±::� s�•' ... ,,......' . ..r- .FEDERAL WAY
Company Name —
s 4frt
Address
City State Zip
Contact Person Phone Fax
Contractor's#(card must be presented) Expiration Date Verified 0 Yes 0 No
n:'F.??,?.:•F,.•:%{{f$'l:f, t}F•tip.�::'/J'f:';�:�{� 'r•�••}i�f•'•+fr •�4 4•;}rf�.
{yy� ■.■ / f f//f: r y`fr{•.F•?,fq-// F y'
ii 4:+. f,+.{i f •}r 'f{kry ff/ f rff.�`•�} t.'
fi. f.:�:{{:�•i::. fffff� :f
Name
•
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side _ _
}• . Existing Use Proposed Use .
Permit includes: Building 0 Plumbing 0 Mechanical 0 Other
Type of Work: Residential 0 New 0 Remodel 0 Number of Units— 0 Deck
0 Commercial 0 Addition `ikAarage 0 Shed 0 Other
Enter 1st Floor /,QO g 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 Availability 0 Sewer Availability 0 On-Site Septic System Availability 0 Project Valuation $
Zoning I Lot Size Existing Bldg Valuation $
.
MPWAMMAPM
���g�o� ��j/''' �'' 0i3,: err
Name /' Address
City State I Zip
Contractor Name 4.n.
Address
City State Zip
Contact Phone Fax
License$ Expiration Date Verified 0 Yes 0 No
Contractor Name A/ Address
/v w
City State Zip
Contact Phone Fax
License I Expiration Date Verified 0 Yes 0 No
r)y tail
+%•`::n:ayry�t+G+:fC/C!r`..:y`Jf/fQf}+ a?f14 .
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Tzite4:RxE(f4ico.........,,•... ............
,:� y}}}�f�.}k}. .4}}.+:;r+f:;$�;'}..,:�::.,i•}i}:ixfF}}•f.{+.:f:ff
. : l'..f_e iiiiii ,', ,3 ., MECHANICAL EVALUATION ONLY $
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
BBO's Wood Stoves 3-15 Tons 14ttil:Uttki::e9 t[#t>:< >::>:::;:»::::: :>:<>::::<;
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 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:- - 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: ,includin:' .fficers and employees,upon the accuracy of the information supplied to the city as a part of this application.
C. r Date: A 499
Owner/Agent: , i
w,
gcvaeo B148fB7 ._ v
Het 252 A
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