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BuErDiNGDMS1ON
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10V
?;FIVE
33530 First Way South
t=
Federal Way, WA 98003
(253) 661-4000
Fax (253) 661-4129
APPLICATION
vVAV
PDT
Fulf-WILDING
PERMIT
F
PLEASE PRINT
APPLICATION # -
Address
- I -
S —
Tenan nown) "EKermor',
Lot #
Assessor's Tax #
L c, L4-903-7-C,5
A&
Building Owner's Name
AddressrI
44-5- *'1
� C' 3�7. o's State
zip gco 3
Phone -26 3
Nature of Work k CM aA41 L%A L,=:,
110
Name (F,M,L
Addres 44
city )-17.
state �jk)A 7j;) tTgoo 3
Contact Person Day Phone
=1 53 —7qt — (a
other Phone Fax
3 - 55'Z -.222 �53
Company Name
Address
City
State Zip
Contact Person
Phone Fax
Contractor's # (card must be presented)
Expiration Date Verified 0 Yes 0 No
R T. C it EC
Name
Address
city I State I ZLP
Contact Person I Phone I Fax
LEGAL DESCRIPTION
tease QQ �M/ J �Tv —r�i �
'ijj°
Existing Use
V
Proposed Use ��,!
QQpp���f-Saki
Permit includes:
❑ Building
❑ Plumbing
❑ Mechanical
❑ Other
Type of Work: ❑ Residential
EI-Commercial
❑ New
0 Addition
El"Remodel
❑ Garage
❑ Number of Units
❑ Shed
❑ Deck
❑ Other
Enter 1 st Floor /�
Area Basement
sq ft
ss ft
2nd Floor
Decks
sq ft 3rd Floor sq ft
sq ft Garage ft
Existing Floor Area a9 SC— sq ft
Proposed Total Area S5 ft
Water A,.il.bilitV ❑
—sq
Sewer Availability ❑ On -Site Se tic System Availability ❑
Project Valuation
$ G 5 C-0
Zoning
Lot Size
Existin2 Bldg Valuation
$
ama
Contractor Name
Address
City
State
Zip
Contact
Phone
Fax
License #
I Expiration Date
Verified ❑ Yes ❑ No
Contractor Name
Address
City
State
Zi
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
.<
B N G ..E .... ••::
Water Closets Z
Sinks
Urinals
Lawn Sprinklers
Bathtubs
Dish Washers
Drinking Fountains
Other
Showers
Electric Water Heaters
Sumps
Lavatories
Washing Machine
Drains
Total Fixture Count
riAlHAIVICA''1N...;;;•.>:, ,. ,....;
MECHANICAL EVALUATION ONLY 5
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
Conv Burner
Duct Work
0-3 Tons
Underground
BBQ's
Wood Stoves
3-15 Tons
Total Unit Cou.rjt
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
attomeys' 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 relianw-eۥUrF city, incl sn its officers and employees, upon the accuracy of the information supplied to the city as a part of this application.
— 2
Owner/Agent: Date: 2
HEME0 8/28/97
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1.i_P _.;
ON
CD
1
SETBACKS & FOOTINGS
Date By
2
FOUNDATION WALLS
Date By
3
PLUMBING GROUNDWORK
Date By
4
SLAB INSULATION
Date By
5
FOOTINGIDOWN SPOUT DRAINS
Date By
6
UNDERFLOOR FRAMING
Date By
7
SHEAR WALLS.
Date By
8
PLUMBING ROUGH -IN
Date By
9
GAS PIPING
Date By
10
MECHANICAL ROUGH -IN
Date By
11
FRAMING
Date By
12
INSULATION
Date By
13
GWS - 1ST LAYER
Date 4,1 By
14
GWS - 2ND LAYER
Date By
15
SUSPENDED CEILING:
Date By
16
PLANNING FINAL
Date By
17
PUBLIC WORKS FINAL
Date By
18
FIRE FINAL
Date By
19
BUILDING FINAL
Date — — By
20
OTHER
Date By
CDO193 (Rev 4197)