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City of Federal Way
.\\) APPLICATION FOR BUILDING RERNi1
-EC 1 7 1997
L..,
PLEASE PRINT jj3s f SQPhCJ��T ON #:
bLI 1l-072 f'
SITE LOCATION Address 28 -�---c� L� Ac c�-
Tenant (if known) Lot #4 'Jv'^'n vZ/ o
Assessor's Tax # l
32 -0So-
Building Owner Name Address
5"..C/VA/E/DES /i j� q, S ./A/C . 6 6/o 3 0 h/TA 1?4.UU
City /u/-1A//[../4 IState AM Zip ?e/e.& IPhone 206 7
Z �¢7/
Nature of Work
Ga,/ST,euCT NEir iR�sio��/cL'
I APPLICANT I
Name (F,M,L) /�//
G/////L:/96- I- Ai -s %NG
Address
G" /o tS "r//c�.v 7 ,e Be__ vo
City T Hbc//L� State GVA d 9 83
Zip 48/
Contact Person I Day Phone Other Phone
NAQf� GAUD//V/E2 2 06- Fax
Z ��- 2 �7/ "2.06—ZqZ-gt'2oq
BUILDING CONTRACTOR I
Company Name
Address
City �C1 K/ti//LA State Am p fe3/R yj
Zi
Contact Person Phone
//',4,2/<" G/4Cl°/ic//C 2 Fax
ZoG Z CIS Zie7i Z06-ZgZ-¢ Z69
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes 0 No
5cA/A/4-,1- - 2 415 PPS 10- 20 --r 8
ARCHITECT I
Name
42A/6 /e0 5S
Address
City V5' E/I%r Z. L ' State,//T zip 9
5 Contact Person �l5
CA �oS s Phone Fax
A 2a6 .36/ - 97o8 36/- r768
LEGAL DESCRIPTION
La T / �7/
EA/TA Aoovs� iv ..Z
Please Complete Reverse Side
CQ0492 R. 4 011
STRUCTURE I Existing Use Proposed Use S(NG.C /-"--/:/h •
'
Permit includes: }uilding ❑ Plumbing ❑ Mechanical ❑ Other
Type of Work: '40 Residential X New ❑ Remodel ❑ Number of Units _ ❑ Deck
❑ Commercial ❑ Addition Garage ❑ Shed ❑ Other
Enter 1st Floor /0 75 sq ft 2nd Floor IC 2 L sq ft 3rd Floor sq ft Existing Floor Area Z y35 sq ft
Area Basement sq ft Decks sq ft Garage $ -CJ sq ft Proposed Total Area 2 iS j sq ft
Water Availability Sewer Availability P • On-Site Septic System Availability ❑ Project Valuation $ /8 3 e,1 c>
Zoning Lot Size /03 .; 3 S I.- Existing Bldg Valuation $
LENDER
Name .5(..,, Address
City
lVlti,u1
`J
�� State Zip
MECHANICAL CONTRACTOR
Contractor Name Address
City
State Zip
Contact
Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBING CONTRACTOR
Contractor Name Address
r
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBING FIXTURE COUNT
Water Closets 3 Sinks 7 Urinals Lawn Sprinklers
Bathtubs 'Z, Dish Washers f Drinking Fountains Other
Showers / Electric Water Heaters Sumps
Lavatories 4 Washing Machine / Drains Total Fixture Count /9--
MECHANICAL UNIT COUNT 4 39SD
Fuel Type (electric/ the;) , /4. 64 5 • Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons
Length of Gas Piping 7,5 C ,F. Range / Air Handling > = 10,000 CFM 30-50 Tons
Furn <100K BTUs 4, i 000 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 3-1 5 Tons Total Unit Count
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 the reliance of the Cit including its officers and employees, upon the accuracy of the information supplied to the City as a part of this
application.
Owner/Agent: �fi..--/._,.V Date:
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Cr
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=c
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