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BUILDINGDIVISION
33530 First Way South,
Federal Way, WA 98003
(253) 661-4000
Fax (253) 661-4129,
at�rU � wa LAPPLICATION FOR BUILDING PERMIT
jj
PLEASE PRINT APPLICATION # . J S " l� V 4
Aicf
Address /� 1. �J n r
Tenant (if known
Lot #
Assessor's Tax #
Building Owner's Name
G.c
Addr s
• 00x
city Diz:n f-�-wState
Zip 2 Z
Phone %-
Nature of Work L c;,-nr
y`;------------
�•:
Name (F,M,L)
0T0 A-1, CES
Address �( f,\ r~ wmTn
Cityv
State WA
zip / a 01
Contact Person
Day Phone
Other Phone
Fax
FEDERAL WAY BUSINESS LICENSE #
Company Name
Address
I0-1 Z;Ff?-rK(/, 11�?T
Contact Person Phone
Contractor's # (card must be presented) Expiration Date
Cs
Fax
Verified ❑ Yes ❑ No
Name
I 1 fCGS P.S
Address 4(
City -Dr �'rt.115�
State WA
Zi �;` D
Contact Person
V/r)
Phone
Zo -8333
Fax
LEGAL DESCRIPTION
Plea- _Complete Reverse Side
w _xisting Use
proposed Use
Permit includes:
❑ Building
❑ Plumbing
❑ Mechanical
❑ Other
Type of Work:
❑ Residential
❑ New
0 Remodel
❑ Number of Units
❑ Deck
❑ Commercial
Cl Addition
❑ Garage
❑ Shed
❑ Other
Enter 1st Floor
sq ft
2nd Floor
sq ft 3rd Floor sq ft
Existing Floor Area
sq ft
Area Basement
sq ft
Decks
sq ft Garage sq ft
Proposed Total Area
sq ft
Water Availability
❑ Sewer Availa'iiit
❑ On -Site
Septic System Availability ❑
Project Valuation
$
Zoning
Lot Size
Existing Bldg Valuation
$
Contractor Name
Address
city
State
Zip
Contact
Phone
]Verified
Fax
License #
Expiration Date
❑ Yes ❑ No
f'I fJ.M BING .CONTRACTOR.
Contractor Name
Address
City
State
Zi
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories j Washing Machine Drains Total Fixture Count
MECHANWA.% • • ,-, :€
Gas Dryer
MECHANICAL EVALUATION ONLY $
Air Handling < = 10,000 CFM 15-30 Tons
Fuel T e (electriclother)
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 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 Federat Way, but only
where such claim arises out ofthe reliance of the city, including its officers and employees, upon the accuracy of the information supplied to the city as a part ofthis application.
Owner/Agent Date:
Buim w.Aw
REV6ED 0120I97
10/20/98 TUE 12:05 FAX 2536614129 CITY OF FEDERAL WAY
STRUCTURE Exia.,ng Use
[a 002
n y
Prumused Use
Pormit Includes:
r0- Building
❑ Plumbing
❑ Mechanical
❑
Other
Type of Work:
❑ Residential
in Commercial
❑ New
❑ Addition
t;4' Remodel
❑ Garage
❑ Number of Units _
❑ Shed
❑
❑
Deck
Other
Enter 1 st Floor :'.:: Y, sq fti
Area Basement sq ft
2nd Floor ____
Decks
sq ft 3rd Floor sq it
sq Ft Garage sq ft
Existing Floor Area
Proposed Total Area
sq it
sq ft
Water Availability
Sewer Availability 25�' On -Sit. Sepiic System Availability U
Project Valuation
2p
Zoning
Lot Sizo
Existing Bldg Valuation
LENDER
Name
W To UTUL-
City Z Y I
MECHANICAL CONFRACTOO.
Addr(A 1 �
State Wf,\- z1p 9 P 10
Contractor Name Address
City Siaze Zip
Ccntacz Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBING CCINUACTOR
Contractor Name Address
city State zip
Contact 1 Phone Fax
License # Expiration Date Verified Cl Yes ❑ No
PLUMBING M'C(= COUNT
Water Closets Sinks
Bathtubs Dish Was
Showers Ele�'i
c a
Lavatories Wang M
z
Urinals
Drinking Fountains
Sumps
Dfains
Lawn Sprinklers
Other
Total FixwTa Count
MECHANICAL UNff COUNT
Fyel Type (electriclother)
Gals Dr r
Air Handling < = 10,000 CFM
1 5-30 Tons
Length of Gas Piping
Range
Air Handling > = 10,000 CFM
30-50 Tons
Furn < 104K BTUs
Gas Log
Unit Heater
50+ Tons
FUrn } 1 0o 87Us
Fans
Miscellaneous
Fuel Tanks
Gas Hwt
Hoo
Boilers
Above Ground
Gonv Burner
Dot Work
0.3 Tons
Underground
BBIx's
ood Stoves
3-15 Tons
-rots] Unit Count
I
olgM0k1MFR: I —tify untrer penalty Of perjury thfit the Information furnished by me is true and correct in the best of my knowledge and further that I am authorized by the owner
ofthc above premises to perform the work for which permit application is made. I furi.hee agree io save harmless the City of Federal Wav as to any claim (including costs, expenses,
and attorneys' fees incurred in Inue,09ation and defense of such cla(m), which may be made by any person, including the undersigned, and filed against the City of Federal Way,
tut v^!; °•r •ry such r19!Yi grfgag otir of the rgjianrg cf the City, including fts nffirrl-, and rmplgyrhs, ufnr rhh @erurary of the lnforma;lan .gupplled;o the City as a cart of this
OORI�CPti4n.
a
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