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\
City of Federal Way
R 00V 0
APPLICATION FOR BUILDING PERMI-OCT 2 71995
CITBULOINC {4EI'T. AY
PLEASE PRINT 7l d S APPLICATION #. 3L_D95_— 0q3 -5
SITE LOCATION Address 7-9-a—
Tenant (if known) Lot #
�S�SYo =
Building Owner Name 6• Address
f2 F F'R.oP�� 77� — �
,.
Sa
City State 6V v4 Zip Xd0�
t�
Phone
Nature of Work G'aN S 5— U
APPLICANT
Name (F,M,U
Address
City �(,V State
Zip 3
Contact Person Day Phone Other Phone
�AeJ
Fax
?E'L-D
BUILDING CONTRACTOR SELEC
Company Name
Address
City
State
Zip
Contact Person Phone
Fax
Contractor's # (card must be presented) Expiration Date
Verified ❑ Yes ❑ No
ARCWTECT
Name
Address
16-q:Z Gv tfr4tY] S%. F 6v2.
city
State
Zip '�—�2_
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
CD0492 (Rev 4/93)
j1'RUCTURE
Existing Use
V AG,,
Permit includes:
3KBuilding
❑ Plumbing
Type of Work:
❑ Residential
,New
❑ Remodel
Commercial
❑ Addition
❑ Garage
Enter 1st Floor *]
1?S; ft
2nd Floor
sq ft 3rd Floor sq ft
Area Basement
sq ft
Decks
sq ft Garage sq ft
Water Availability
Sewer Availability On -Site Septic System Availability ❑
Zoning 'Q
.�
Lot Size
S
LENDER
Name
City
MECHANICAL CONTRACTOR
Contractor Name
State
Proposed Use
❑ Mechanical❑G Other
❑ Number of Units ❑ Deck
❑ Shed ❑ Other
Existing Floor Area sq ft
Proposed Total Area sq ft
Project Valuation S -7—Zq
Existing Bldg Valuation �"
ess
Address
C�J c
Zip
City State Zip
Contact Phone Fax
U
License # I Expiration Date I Verified ❑ Yes ❑ No
PLUM NG' CONTRACTOR
7- �7 Z .
Contractor Name
Address
City
State
Zip
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
PLUMBING FIXTURE COUNT
Water Closets
Bathtubs
Showers
Lavatories
49c� T �
Sinks
Dish Washers
Electric Water Heaters
Washing Machine
>9� / 6,4770,4J
Urinals
Drinking Fountains
Sumps
Drains
Lawn Sprinklers
Other
Total Fixture Count
MECHANICAL UNIT .COUNT
T — —.
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 Cnunt
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. 1 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 su c A ices out Af 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. j��j
Ow r1A anDate: 10Z II