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�1 City of Federal Way
L'CATION F
— — 14EGff"4118
PLEASE PRINT ?��6 2 M 1996 Btk57eitel
/�: ::....:.,. APPLICATION#: - 1 J iS�; z'�'.`..�:%�'�� � < . f �::::?�SiE: : dregs /
;kJ
t(if known) Lot# Assessor's Tax#
feF I
: Idi g Owner Nan
Address
%tTha 221S ti H-f} 40.-14 c' •- s;-- _V75 /3/1-r 4UC S•'
Gam. S 2��
Cityg��v,JF �State )4- Zip /ar�6�/A� Phone 6/3 i kt
Nature of Work e
PiMDJe Gt 1Nk. Menu-Ine,cl "e°Q,�,�q ,_wits, Pipe , /cal
N e(F,M
C. •
t'tI L S .. 'r v LYl b t
Add33$ I 9U
City
State ,It .. Zip I .98.0�j
o tact PerRlip Day Pho a Ot Phone �G► _
..i
vett.
77
•
:M.�.!.�,if�.�.�1.��':^.:::ram?'f�i:•r':f'i�;y::}:ii:+i:�::iii:Gr}y:.:.:i':.y........
.....................:}4 Ap;.J:14„}}}}Y.O}5^. O .x,vk',F,:{<✓}rii}`}C•ii
r •�
Co any Name
..cQK4L QS 4 /egg
Address •
City State Zip
on act Peraci71 ii
Phone
Fax
9f 2 77
Contractor's #(card must be presented)
Expiration Date Verified 0Yes 0 No
Je)Z�C�'C-04/2LC'O
}i: .J v".i':t..f•}Vl.'i'}•i 'i;$fi:ii'}t:
T.!!.id f41.•M '�' r'r+ Y,n:.: i''.:.... }trilr i} .,fir,}i�'•Wf
....... ....+J$::'I:G:r:..::•}:::;:n�{,?i•.rfij}:};vn:i}:•ri4}:4:•it ti?:!F`:':
Name
Addre s
City State I Zip
P
Contact Person Phone
Fax
LEGAL DESCRIPTION �1 I l
it- l9 QF ET (/'�1?s . s. C ''7't_.
&— 97 ` t--4�/s.' 71'-'2
ePt-- ce_is or
Please Complete Reverse Side
C00492 Giev 4/931
STRYJCTCJR� ring tin ' • po'— sea uga7�
Permit includes: L. ..wilding 0 Plumbing .. Mechanical • 04v/, czL
i
Type of Work: 0 Residential 0 New Afr Remodel 0 Number of Units 0 Deck
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 9 Dim sq ft
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area 4Orl�p sqft •4�i�c,
Water p
R
t r Availability :�:s<:E»>::::'.:::.;0 Sewer r Availability
e e A 0 On-Site Septic$ see f.,.
tYrem Availability0 `.:�c::; :.�:<;;><;�<»::<'� <;:>::>:<::<:;>::>'�>,. ....r.... . ..
Y .......... ;,F,.;F.:f4g�;::alf�p4a�:•:i$o���j?�4,�'�':: -:€r/.l
Zoning
nln
g 'Lot Size
.''':Bide•:::"?:�' :�: :#: ` ;�:: :.�::` � : :.'•.``�.�::::.: ,
I1 X 41 e(!?S 19�%.; .•: r.... F.,,r:r.:r! t,
...... :.:::.:
gym.::::::.:. .M::.:_:::::E;.::::::.::.:::Mg::::::.::.:::::».:::.::.:
Name/ Address
N(/
City State I Zip
MECHANICAL` :' l taXYRIang
C�o/q lactor Name Address
NI -
City State Tap
' Contact Phone Fax
License I Expiration Date Verified 0 Yes 0 No
Contr ctor Name Address
14 A-
City State Zip
Contact Phone Fax
License I Expiration Date Verified 0 Yes 0 No
.....h?1tli`:::0:•is4:•i�:K:i siii:4:•i�•ifrii}:ti.ii}:•ii}:4i:'i^'f.:F:•i:..'i r:'.•:'..
Water Closets is Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters
—
Lavatories Washing Machine Drains #T ta1: `i t e: iritt' "<<> ::
Fuel Typ • Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons
Length of Gas Piping Air Handling > = 10,000 CFM 30-50 Tons
Furn <100K BTUs Gas Log Unit Heater 50+ Tons
Furn >100 BTUs Fans laneous Fuel Tanks
Gas Hwt Hood Boilers Above Ground
Cony Burner Duct Work 0-3 Tons Underground
BBfl's Wood Stoves 3-15 Tons <'gifi::,;".".".,ai L<.><.': ::: ::<::«<z<::>::::
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 pemiit 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, ludin its officers and employees,upon the accuracy of the information supplied to the City as a part of this
application.
/
Owner/Agent. 1 Oat.: /914
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