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cavarG BUILDING DIVISION
ECIEJ 33530 First Way South
R E C E I V E D Federal Way,WA 98003
1-4000
J 1998Fax(206)661-4129c
APPLICAT . _�} t�H TBUILDING PERMIT
PLEASE PRINT
APPLICATION# 1'O ci Q tiQrz
. Address 21 e/2-5 2 A ✓tA
Tenant(if known) Lot# Assessor's Tax#
Kul 4I4U4ZBo6.01114r .
Building Owner's Name Address
City 1(•IM State WA Zip C:;telCira� Phone
Nature of Work Op o.4d
r,V& .`. ^'r�OiS, R \oC Q .rAck I
Name(F,M,L)
1`r(�
Address
City State Zip
ContMer oq Day P ►nIe Other Phone Fax
ja <,r ??f�l.{.::'it.v'J+f..'ffi:xr•.t:.•f{}'Fr'l�Fff'}:{}:?+.fff'i::;+{iF.
r..
`�y+ {�yy�("��
Company Name / / /�'►r/ �,A�
Address , x/4. E ,i
i1' eoli
City - -4 VfJ' . GI/A State k A Zip
Contact Person /�'f'L�� /�/ Phone 4zs Fax s
�5/-937o -�g'(d�t
Contractor's #(card must be presented) f�/ 54077/ Expiration Da / Verified 0 Yes 0 No
.}•{�... :�.Ri�::v:;::'iIfr'fir.?4^{�i::i??;:::i`i}:i::i?::iiYr:}�i':%
Name
11112(
Address 3lf/9 e.„,-
City PQ. f'Y T19"y5� State '(//f Zip 9i'02
Contact Person Phone
Ih/ � 2C (> ,/ ZA?r Fax 34792
COL L. >C11i7-
LEGAL DESCRIPTION
Please Complete Reverse Side
,... . ...
::::::::::::0.*:::::.* •
61010. ,is .. • ' y •.; •• Existing Use . //4(2LE F I9 iii 1 L L /2g..-S Proposed Use '•/Al-6,t.a. Fityki 1 Lei
Permit includes: Cil/Building 0 Plumbing 0 Mechanical 0 Other
Type of Work: d Residential 0 islew Ole Remodel 0 Number of Units 0 Deck
0 Commercial LWAddition 0 Garage 0 Shed 0 Other
Enter 1st Floor 212 ,sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area 2200 sq ft
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area 39 i 2- sq ft
Water Availability 0 Sewer Availability 0 On-Site Septic System Availability 0 Project Valuation $
Zoning I Lot Size 2 2,o ic 4, Existing Bldg Valuation $
ICTSERINA,x,m,,,..„,,girgo4 .f.,A:,
Name Address
City State I ZIP
1.6.7rEctaiglitaffir
Contractor Name Address
City State ..Zip
Contact Phone Fax
, -
License# Expiration Date Verified 0 Yes 0 No
Iiiiiiiiiiiiitlibliiiiiiiiiititilign
Contractor Name Address
I
City State Zip
Contact Phone _Fax
License # Expiration Date Verified 0 Yes 0 No
I itsiwirdrogilwairisiraiii
Water Closets I Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers 1 Electric Water Heaters Sumps
...:.•:i:::i:iiIii:ii:i::iiig•i::oii:•.. i.::.,..:,i]iii::.:iiiiii•]iii:iiiiiiniii::ii
Lavatories a Washing Machine Drains :Tekellii3Or.jiKQ0iiirit:11;i::::=MOM
i::.*:i:if§:im:if:*ifi:i:ii:Kii:i*ft:mi:K:iii:i:i:i:I:i:iiiii:K::•:1:imi:Kii:x:iiiiiiiiiii:iii•::::imiaiimii
MECHANICAVUNCIWOUNINSOMil 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
•"!?-„.„,::::::::::::::::::....:••••.•::::::::::::.:...::::::::::::::::::::::::::i,i::: :ii:::K•i••:i•i•i*::••i:
BBQ's Wood Stoves 3-15 Tons TikitilViji(Oriiiiitniiii:ii:iiiiniiiiiiiiiiii•ii:iliiiii::
DISCLAIMER:I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge,and futther,that I am authorized by the own 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,
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 o
where such claim arises 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.
•
Owner/Agent: /.<‘40_ f 1/1 ( .- 1(1....- Date:
,
WIL01143.APP
Reno 12/11/98
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