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RECEI\/ED
City of Federal Way JUL 3 0-4g.". El=1"-Irw4Fit- 1996
APPLICATION FOR BUILDING PERMIT
,CITY OF FEDERAL WAY
1HUILDING OEPT. t
�n r
PLEASE PRINT APPLICATION #: 011 q W_0307
SITE L. CATION (Address 2iiOo$/
Teagnt(if known) Lot Lot#
l�.l y Assessor's Tax #
`� l (AO —Otto
Building Owner NA, Address
° & M cac E. .31ob0 i3/trAve- Se '�2o6
Citykg.o.
l Rd JE [State wA" Zip
97066-133/ I Phone 443.-vf0z
Nature of Works 4..p. ITS iig- I..141..-6.tesa tit,"
en...11.re.IIGT Able=u., nnF1cF5
APPLICANT ] /
Name(F,M,
J.C. 1 ,c,4,a.42sc. ���-rizvc..-rrou
Address
33741 9Avve S .
city4A.L It t y
State iti4-- I Zip gra,3
Ccqyn�4�ct Per�s j r Day Phone Other Phone
JoL. ax
,,L �Ccc s 8"3�'-102.0fo- �l6 2f77 FS"38'=
a955
I BUILDTh G CONTRACTOR I
Corn any Name
I"IE its 4P .Ie r
Address
City
State Zip
Contact Person
Phone Fax
Contractor's #(card must be presented)
Expiration Date Verified 0 Yes 0 No
1ARCHITI CT
Name n -
Ni
Addres
City
State Zip
Contact Person
Phone Fax
i
LEGA DESCRIPTION �^
�, ICI "F I1 j t / 4MfUS ..-�.
JbL. '77 VZ
Please Complete Reverse Side
C00492(Rev 4/931 I
STRUCTURE ing Use oil •
W posed Use T
Permit includes: Building 0 Plumbing ❑ Mechanical ` f ❑ Other
Type of Work: 0 Residential 0 New RT Remodel 0 Number of Units 0 Deck
_ yI Commercial 0 Addition 0 Garage 0 Shed 0 Other
Enter 1st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area_ Z2'I` sq ft
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area 2$I4. sq ft
Water Availability 0 Sewer Availability 0 On-Site Septic System Availability 0 Project Valuation Sfe{,pCO
Zoning 6 P Lot Size Existing Bldg Valuation $2
I.
w►.
LENDER
Name Address
NIA'
City State Zip
MECHANICAL CONTRACTOR
Contracto Name Address
City (((( State Zip
Contact �Ph. e Fax
License # / Expiration Date Verified 0 Yes 0 No
PLUMBING CONTRACTOR> ,%
Cont Name // Address
City
State Zip
/
Contact Phone Fax
License # / / Expiration Date Verified 0 Yes 0 No
/ /
PLUMBING FIXTURE COUNT /�
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs / Dish Washers Drinking Fountains Other
Showers Electric Water Heaters umps
/
Lavatories / Washing Machine Dr.' s Total Fixture Count
/
MECHANICAL COUNT
Fuel Type (electri other) Gas Dryer Air Handling < = 1,000 CFM 15-30 Tons
Length of Gas.Piping Range Air Handling > = 10,1 4 0 CFM 30-50 Tons
Furn <10(*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 Un rground
BBQ's Wood Stoves 3-15 Tons Total Unit nt
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 City,including its officers and employees,upon the accuracy of the information supplied to the City as a part of this
: ::t:.
ppli
61, Date: 7' 74
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